Healthcare Provider Details

I. General information

NPI: 1013893304
Provider Name (Legal Business Name): MADISON PACHUCY MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2407 LAPORTE AVE
FORT COLLINS CO
80521-2211
US

IV. Provider business mailing address

2407 LAPORTE AVE
FORT COLLINS CO
80521-2211
US

V. Phone/Fax

Practice location:
  • Phone: 970-482-7420
  • Fax:
Mailing address:
  • Phone: 970-482-7420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number24510478
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: