MEDICARE: MS. CHERYL ELIZABETH FITZSIMMONS M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	0442122	CO

General Provider Information

NPI Number	:	1154634657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERYL ELIZABETH FITZSIMMONS M.A.

Provider Business Mailing Address
First Line	:	14985 PRISTINE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-3545
Country	:	US
Telephone Number	:	719-510-8189
Fax Number	:	719-527-9828

Provider Business Practice Location Address
First Line	:	14985 PRISTINE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-3545
Country	:	US
Telephone Number	:	719-510-8189
Fax Number	:	719-527-9828

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2010
Last Update Date	:	07/26/2010

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