=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538364260
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENNETH W GABLER AU.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2007
-----------------------------------------------------
Last Update Date | 11/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1020 JOHNSON RD
-----------------------------------------------------
City | GOLDEN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80401-6002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-723-5125
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 164
-----------------------------------------------------
City | LARKSPUR
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80118-0164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-345-9139
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 1456
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 560
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------