Provider Demographics
NPI:1205211448
Name:PLATZ, ELISE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:PLATZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 GOLDEN CIR
Mailing Address - Street 2:112
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3624
Mailing Address - Country:US
Mailing Address - Phone:503-569-0324
Mailing Address - Fax:
Practice Address - Street 1:1250 GOLDEN CIR
Practice Address - Street 2:112
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-3624
Practice Address - Country:US
Practice Address - Phone:503-569-0324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002152235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist