Provider Demographics
NPI:1275513061
Name:MARY NEL LLC
Entity Type:Organization
Organization Name:MARY NEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-412-6394
Mailing Address - Street 1:2505 W PLUM ST
Mailing Address - Street 2:
Mailing Address - City:FT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-3144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1113 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-4722
Practice Address - Country:US
Practice Address - Phone:970-499-8407
Practice Address - Fax:970-667-8383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO53539745Medicaid