Healthcare Provider Details

I. General information

NPI: 1215844170
Provider Name (Legal Business Name): KATHLEEN FARRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2059 HIWAN DR
EVERGREEN CO
80439-5907
US

IV. Provider business mailing address

29313 THIMBLEBERRY LN
EVERGREEN CO
80439-8562
US

V. Phone/Fax

Practice location:
  • Phone: 303-982-5020
  • Fax:
Mailing address:
  • Phone: 720-519-3275
  • 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: