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General NPI Number Information
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NPI Number | 1619682978
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Entity Type | Individual
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Provider Name | AVERY POLK
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Gender | Female
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Dates
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Enumeration Date | 01/20/2023
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 1860 N LINCOLN ST
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City | DENVER
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State | CO
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Zip | 80203-7301
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Country | US
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Telephone | 720-423-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 122 DARTEZE DR
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City | LAFAYETTE
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State | LA
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Zip | 70508-8111
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Country | US
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Telephone | 337-541-8519
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 8833
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 24492689
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License Number State | CO
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