Provider Demographics
NPI:1225189632
Name:HURST, KATHLEEN M (MA CCCSLP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:HURST
Suffix:
Gender:F
Credentials:MA CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10775 W PARKHILL AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-5552
Mailing Address - Country:US
Mailing Address - Phone:720-922-3298
Mailing Address - Fax:303-948-2764
Practice Address - Street 1:10775 W PARKHILL AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-5552
Practice Address - Country:US
Practice Address - Phone:720-922-3298
Practice Address - Fax:303-948-2764
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18030025Medicaid