Healthcare Provider Details

I. General information

NPI: 1598583478
Provider Name (Legal Business Name): BRESCIA DAWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/24/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 COFFMAN 2162 UNIT G
LONGMONT CO
80501
US

IV. Provider business mailing address

201 COFFMAN ST # 2162
LONGMONT CO
80501-5918
US

V. Phone/Fax

Practice location:
  • Phone: 435-503-2010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: