Healthcare Provider Details

I. General information

NPI: 1760024624
Provider Name (Legal Business Name): MOLLY DAMICO M.S. SLP, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BLAKE AVE
GLENWOOD SPRINGS CO
81601-4227
US

IV. Provider business mailing address

1906 BLAKE AVE
GLENWOOD SPRINGS CO
81601-4259
US

V. Phone/Fax

Practice location:
  • Phone: 970-384-7550
  • Fax: 970-384-8162
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number354296
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP.0004469
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: