Provider Demographics
NPI:1063638575
Name:CIGOY, MITCHELL W (MACCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:W
Last Name:CIGOY
Suffix:
Gender:M
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-3442
Mailing Address - Country:US
Mailing Address - Phone:719-565-7314
Mailing Address - Fax:
Practice Address - Street 1:1106 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-3442
Practice Address - Country:US
Practice Address - Phone:719-565-7314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000350235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ505167Medicaid