Healthcare Provider Details

I. General information

NPI: 1811001969
Provider Name (Legal Business Name): AMY S CIVIELLO M.A.CCC-A,FAAA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 UNION BLVD SUITE 421
LAKEWOOD CO
80228-1830
US

IV. Provider business mailing address

200 UNION BLVD SUITE 421
LAKEWOOD CO
80228-1830
US

V. Phone/Fax

Practice location:
  • Phone: 720-446-2828
  • Fax: 720-446-0941
Mailing address:
  • Phone: 720-446-2828
  • Fax: 720-446-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number218
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: