Healthcare Provider Details

I. General information

NPI: 1629627450
Provider Name (Legal Business Name): MADELIN CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W CROSS DR STE 120
LITTLETON CO
80123-2225
US

IV. Provider business mailing address

1295 RACE ST APT 201
DENVER CO
80206-2852
US

V. Phone/Fax

Practice location:
  • Phone: 720-542-8737
  • Fax:
Mailing address:
  • Phone: 619-988-0198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPSLP.0001166
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: