Provider Demographics
NPI:1235553199
Name:WARREN, SAMANTHA ELAINE (AUD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:ELAINE
Last Name:WARREN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:SAMANTHA
Other - Middle Name:ELAINE
Other - Last Name:SCHOPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:5942 OAK MEADOWS BLVD
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80504-6436
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4745 ARAPAHOE AVE STE 130
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303
Practice Address - Country:US
Practice Address - Phone:303-443-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO709231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO55631070Medicaid
CO342584YT0JMedicare PIN