Provider Demographics
NPI:1578110433
Name:GOTTSCH, ALLISON JOY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:JOY
Last Name:GOTTSCH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17700 S GOLDEN RD STE 210
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-6019
Mailing Address - Country:US
Mailing Address - Phone:303-990-7862
Mailing Address - Fax:720-617-8001
Practice Address - Street 1:17700 S GOLDEN RD STE 210
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-6019
Practice Address - Country:US
Practice Address - Phone:303-990-7862
Practice Address - Fax:720-617-8001
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-23
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003652235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000179889Medicaid