MEDICARE: MRS. ANGELA LEIGH RUNYON M.A., CCC-SLP

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	12062970	CO

General Provider Information

NPI Number	:	1962618470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA LEIGH RUNYON M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	1220 CLAYTON ST APT 1
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-3274
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 CLAYTON ST APT 1
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-3274
Country	:	US
Telephone Number	:	720-941-7447
Fax Number	:

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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Directions to “ MRS. ANGELA LEIGH RUNYON M.A., CCC-SLP” Practice Location

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