Provider Demographics
NPI:1497308373
Name:ANZIVINO, NICCOLE KRISTINE
Entity Type:Individual
Prefix:
First Name:NICCOLE
Middle Name:KRISTINE
Last Name:ANZIVINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 MILWAUKEE ST STE 203
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1627
Mailing Address - Country:US
Mailing Address - Phone:714-615-7682
Mailing Address - Fax:
Practice Address - Street 1:1690 MILWAUKEE ST STE 203
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1627
Practice Address - Country:US
Practice Address - Phone:714-615-7682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSLP.0000529235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist