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General NPI Number Information
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NPI Number | 1609170141
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Entity Type | Individual
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Provider Name | MARY KATHERINE MOSHER-STATHES LSLS CERT AVT
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Gender | Female
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Dates
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Enumeration Date | 12/25/2010
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Last Update Date | 12/25/2010
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Provider Practice Location Address
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Address Line | 441 SAINT PAUL ST
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City | DENVER
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State | CO
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Zip | 80206-4336
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Country | US
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Telephone | 303-257-5943
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Fax |
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Provider Business Mailing Address
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Address Line | 441 SAINT PAUL ST
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City | DENVER
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State | CO
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Zip | 80206-4336
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Country | US
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Telephone | 303-257-5943
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 0454429
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 70712246
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License Number State | CO
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