Healthcare Provider Details

I. General information

NPI: 1578551024
Provider Name (Legal Business Name): UNIVERSITY OF NORTHERN COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 20TH ST 55
GREELEY CO
80639-0001
US

IV. Provider business mailing address

501 20TH ST 55
GREELEY CO
80639-0001
US

V. Phone/Fax

Practice location:
  • Phone: 970-351-2012
  • Fax: 970-351-1601
Mailing address:
  • Phone: 970-351-2012
  • Fax: 970-351-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD NICKESON
Title or Position: ASSOCIATE VP ADMINISTRATION
Credential:
Phone: 970-351-3966