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1301 Fortino Blvd Pueblo CO 81008-2032 | |
| (719) 597-0822 | |
| (719) 599-4606 |
| Full Name | |
|---|---|
| Speciality | Speech-language Pathologist |
| Location | 1301 Fortino Blvd, Pueblo, Colorado |
| Authorized Official Name and Position | Rebecca Newman (BILLING MANAGER) |
| Authorized Official Contact | 7195970822 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
685 Citadel Dr E Ste 580 Colorado Springs CO 80909-5381 Ph: (719) 597-0822 | 1301 Fortino Blvd Pueblo CO 81008-2032 Ph: (719) 597-0822 |
| NPI Number | 1801401153 |
|---|---|
| Provider Enumeration Date | 09/14/2020 |
| Last Update Date | 09/15/2020 |
| Certification Date | 09/15/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801401153 | NPI | - | NPPES |
| 12000256 | Medicaid | CO |
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