Provider Demographics
NPI:1114148335
Name:MARION DOWNS CENTER
Entity Type:Organization
Organization Name:MARION DOWNS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:C
Authorized Official - Last Name:WAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC A
Authorized Official - Phone:303-322-1871
Mailing Address - Street 1:4280 HALE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220
Mailing Address - Country:US
Mailing Address - Phone:303-322-1871
Mailing Address - Fax:303-399-3411
Practice Address - Street 1:4280 HALE PARKWAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220
Practice Address - Country:US
Practice Address - Phone:303-322-1871
Practice Address - Fax:303-399-3411
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARION DOWNS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-02
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X, 235Z00000X, 235Z00000X
CO427231H00000X
CO284231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0703Medicare ID - Type Unspecified
T0703Medicare ID - Type Unspecified