Healthcare Provider Details

I. General information

NPI: 1861963183
Provider Name (Legal Business Name): KATHRYN ELIZABETH IZQUIERDO M. A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2018
Last Update Date: 12/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4495 HALE PKWY
DENVER CO
80220-6210
US

IV. Provider business mailing address

1378 WILLOW OAK RD
CASTLE ROCK CO
80104-8566
US

V. Phone/Fax

Practice location:
  • Phone: 844-757-7450
  • Fax: 855-715-3504
Mailing address:
  • Phone: 315-481-4277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: