MEDICARE: COLORADO CITY UNIFIED SCHOOL DISTRICT

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	SLPA6408	AZ

General Provider Information

NPI Number	:	1790001204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO CITY UNIFIED SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	255 NORTH COTTONWOOD STREET
Second Line	:
City	:	COLORADO CITY
State	:	AZ
Zip	:	86021-0309
Country	:	US
Telephone Number	:	928-875-9000
Fax Number	:	928-875-8068

Provider Business Practice Location Address
First Line	:	325 NORTH COTTONWOOD STREET
Second Line	:
City	:	COLORADO CITY
State	:	AZ
Zip	:	86021-0309
Country	:	US
Telephone Number	:	928-875-9000
Fax Number	:	928-875-8068

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MS. CAROL TIMPSON
Credential	:
Telephone Number	:	928-875-9000

Provider Enumeration Date	:	04/09/2010
Last Update Date	:	04/09/2010

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Directions to “COLORADO CITY UNIFIED SCHOOL DISTRICT ” Practice Location

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