Healthcare Provider Details

I. General information

NPI: 1801272778
Provider Name (Legal Business Name): KELLY GORMAN MS CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 CHERRYVILLE RD C/O AAC SPECIALISTS, LLC
GREENWOOD VILLAGE CO
80121-1504
US

IV. Provider business mailing address

1885 CHERRYVILLE RD C/O AAC SPECIALISTS, LLC
GREENWOOD VILLAGE CO
80121-1504
US

V. Phone/Fax

Practice location:
  • Phone: 303-204-5188
  • Fax: 303-761-9491
Mailing address:
  • Phone: 303-204-5188
  • Fax: 303-761-9491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14066997(ASHA)
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: