Healthcare Provider Details

I. General information

NPI: 1275855827
Provider Name (Legal Business Name): TRICIA ANN GUDRIDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W 13TH AVE
LAKEWOOD CO
80214-4700
US

IV. Provider business mailing address

1225 S ONEIDA ST #215
DENVER CO
80224-3119
US

V. Phone/Fax

Practice location:
  • Phone: 303-770-4682
  • Fax: 303-770-4812
Mailing address:
  • Phone: 303-436-7825
  • Fax: 303-436-7380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: