Healthcare Provider Details

I. General information

NPI: 1225942295
Provider Name (Legal Business Name): IRENA SLAVKOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19590 E MAINSTREET STE 204
PARKER CO
80138-7371
US

IV. Provider business mailing address

578 S FIELD CT
LAKEWOOD CO
80226-2959
US

V. Phone/Fax

Practice location:
  • Phone: 702-202-9462
  • Fax:
Mailing address:
  • Phone: 702-202-9462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0027638
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: