Healthcare Provider Details

I. General information

NPI: 1811200264
Provider Name (Legal Business Name): EMILY ANNE CONKLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 LEETSDALE DR
DENVER CO
80224-1588
US

IV. Provider business mailing address

17931 E EUCLID PL
CENTENNIAL CO
80016-3156
US

V. Phone/Fax

Practice location:
  • Phone: 303-331-9963
  • Fax:
Mailing address:
  • Phone: 303-725-4336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12009821
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: