Provider Demographics
NPI:1518365972
Name:DUVALL, CARLY (AUD)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:DUVALL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:FOREMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:799 E 3RD ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5793
Mailing Address - Country:US
Mailing Address - Phone:970-375-2369
Mailing Address - Fax:
Practice Address - Street 1:799 E 3RD ST STE 1
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5793
Practice Address - Country:US
Practice Address - Phone:970-375-2369
Practice Address - Fax:970-375-9054
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD.0000722231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66225876Medicaid
CO023645OtherKAISER COMMERCIAL NUMBER
CO023645OtherKAISER COMMERCIAL NUMBER