Healthcare Provider Details

I. General information

NPI: 1558714485
Provider Name (Legal Business Name): SARAH RANDOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 BLAKE STREET
DENVER CO
80205
US

IV. Provider business mailing address

1164 S ACOMA ST UNIT 527
DENVER CO
80210-1656
US

V. Phone/Fax

Practice location:
  • Phone: 720-419-2187
  • Fax:
Mailing address:
  • Phone: 818-383-6239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0002507
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: