Provider Demographics
NPI:1326350109
Name:AVERY, ADRIANNA ACKERMAN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ADRIANNA
Middle Name:ACKERMAN
Last Name:AVERY
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 1:1450 BLACK PINE CT
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-7610
Mailing Address - Country:US
Mailing Address - Phone:970-590-9241
Mailing Address - Fax:
Practice Address - Street 1:1450 BLACK PINE CT
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7610
Practice Address - Country:US
Practice Address - Phone:970-590-9241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO191025235Z00000X
CO12130383235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist