MEDICARE: MARGAUX DART-GREENOUGH

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

General Provider Information

NPI Number	:	1518632959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGAUX DART-GREENOUGH

Provider Business Mailing Address
First Line	:	127 FISHBACK AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-2329
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	127 FISHBACK AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-2329
Country	:	US
Telephone Number	:	970-310-1067
Fax Number	:

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

Provider Enumeration Date	:	08/09/2021
Last Update Date	:	08/09/2021

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Directions to “ MARGAUX DART-GREENOUGH ” Practice Location

Language	Start Address	Practice Location

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