Provider Demographics
NPI:1306190830
Name:TINTZMAN SLP
Entity Type:Organization
Organization Name:TINTZMAN SLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FISK
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC,SLP
Authorized Official - Phone:970-689-3333
Mailing Address - Street 1:6933 ROSEMONT CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-6969
Mailing Address - Country:US
Mailing Address - Phone:970-689-3333
Mailing Address - Fax:970-689-3337
Practice Address - Street 1:6933 ROSEMONT CT
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-6969
Practice Address - Country:US
Practice Address - Phone:970-689-3333
Practice Address - Fax:970-689-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12111845235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02581701Medicaid
CO94851069Medicaid