Provider Demographics
NPI:1558956037
Name:NITTA, AMY M
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:NITTA
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 1:4045 WADSWORTH BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4624
Mailing Address - Country:US
Mailing Address - Phone:303-953-3163
Mailing Address - Fax:303-245-0726
Practice Address - Street 1:8020 LEE DR
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-2078
Practice Address - Country:US
Practice Address - Phone:303-422-1755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0004270235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist