Healthcare Provider Details

I. General information

NPI: 1366713976
Provider Name (Legal Business Name): SAMANTHA NICHOLE CONLEY M.S. SLP CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 ST PAUL ST
DENVER CO
80206
US

IV. Provider business mailing address

11849 RIDGE PKWY #1127
BROOMFIELD CO
80021-5084
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-2040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2011008030
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0000055
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: