Provider Demographics
NPI:1154860401
Name:HURLEY, ARTELIA VAUGHN (MS SLPCCC)
Entity Type:Individual
Prefix:MRS
First Name:ARTELIA
Middle Name:VAUGHN
Last Name:HURLEY
Suffix:
Gender:F
Credentials:MS SLPCCC
Other - Prefix:MISS
Other - First Name:ARTELIA
Other - Middle Name:VAUGHN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3619 ESTATES CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CO
Mailing Address - Zip Code:80118
Mailing Address - Country:US
Mailing Address - Phone:850-582-0781
Mailing Address - Fax:
Practice Address - Street 1:3619 ESTATES CIR
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CO
Practice Address - Zip Code:80118-5625
Practice Address - Country:US
Practice Address - Phone:850-582-0781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001553235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL$$$$$$$$$Medicaid