Provider Demographics
NPI:1083756639
Name:NUNEMAKER, KATHY (MA)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:
Last Name:NUNEMAKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21150
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-4150
Mailing Address - Country:US
Mailing Address - Phone:303-546-9158
Mailing Address - Fax:303-546-9107
Practice Address - Street 1:4105 GILPIN DR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2527
Practice Address - Country:US
Practice Address - Phone:303-931-8313
Practice Address - Fax:303-543-8283
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07004849Medicaid
CO07004849Medicaid