Healthcare Provider Details

I. General information

NPI: 1528618428
Provider Name (Legal Business Name): LONGS PEAK AUDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 REMINGTON ST
FORT COLLINS CO
80525-2602
US

IV. Provider business mailing address

3100 REMINGTON ST
FORT COLLINS CO
80525-2602
US

V. Phone/Fax

Practice location:
  • Phone: 970-266-8380
  • Fax: 303-857-6689
Mailing address:
  • Phone: 970-266-8380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: DR. BRITTANY MICHELE MATHISEN
Title or Position: PRESIDENT
Credential: AU.D.
Phone: 303-263-6705