Provider Demographics
NPI:1114255171
Name:CARRASCO, KATHLEEN GRACE COLLINS (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:GRACE COLLINS
Last Name:CARRASCO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:
Other - Last Name:CARRASCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18551 E 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-8519
Mailing Address - Country:US
Mailing Address - Phone:720-299-3318
Mailing Address - Fax:
Practice Address - Street 1:18551 E 160TH AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-8519
Practice Address - Country:US
Practice Address - Phone:720-299-3318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225272235Z00000X
CO12011697235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist