Provider Demographics
NPI:1578165221
Name:ELMORE, KRISTINE AMY (SLP)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:AMY
Last Name:ELMORE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:AMY
Other - Last Name:TOWNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2813 SECCOMB ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6211
Mailing Address - Country:US
Mailing Address - Phone:970-775-4800
Mailing Address - Fax:
Practice Address - Street 1:2290 E PROSPECT RD STE 4
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-9768
Practice Address - Country:US
Practice Address - Phone:970-305-4730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSLP.0000728235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist