Provider Demographics
NPI:1497749832
Name:SIMONINI-WEBER, CLARISSE ANN (MA CCC)
Entity Type:Individual
Prefix:MS
First Name:CLARISSE
Middle Name:ANN
Last Name:SIMONINI-WEBER
Suffix:
Gender:F
Credentials:MA CCC
Other - Prefix:MS
Other - First Name:CLARISSE
Other - Middle Name:ANN
Other - Last Name:SIMONINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC
Mailing Address - Street 1:4280 HALE PKWY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3724
Mailing Address - Country:US
Mailing Address - Phone:303-322-1871
Mailing Address - Fax:303-399-3411
Practice Address - Street 1:4280 HALE PKWY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3724
Practice Address - Country:US
Practice Address - Phone:303-322-1871
Practice Address - Fax:303-399-3411
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11552549Medicaid