Provider Demographics
NPI:1609170141
Name:MOSHER-STATHES, MARY KATHERINE (LSLS CERT AVT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHERINE
Last Name:MOSHER-STATHES
Suffix:
Gender:F
Credentials:LSLS CERT AVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 SAINT PAUL ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4336
Mailing Address - Country:US
Mailing Address - Phone:303-257-5943
Mailing Address - Fax:
Practice Address - Street 1:441 SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4336
Practice Address - Country:US
Practice Address - Phone:303-257-5943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-25
Last Update Date:2010-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0454429174H00000X
CO707122462355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No174H00000XOther Service ProvidersHealth Educator