Provider Demographics
NPI:1578543575
Name:SIMMS, BRIAN ALLEN (MA CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ALLEN
Last Name:SIMMS
Suffix:
Gender:M
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 1:13428 MARION ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-1950
Mailing Address - Country:US
Mailing Address - Phone:720-317-6679
Mailing Address - Fax:303-604-6849
Practice Address - Street 1:13428 MARION ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-1950
Practice Address - Country:US
Practice Address - Phone:720-317-6679
Practice Address - Fax:303-604-6849
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84958847Medicaid