Provider Demographics
NPI:1619326931
Name:FOGARTY, RACHEL MAUREEN (SLP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MAUREEN
Last Name:FOGARTY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 UINTA WAY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7110
Mailing Address - Country:US
Mailing Address - Phone:303-432-8487
Mailing Address - Fax:303-536-1854
Practice Address - Street 1:495 UINTA WAY
Practice Address - Street 2:SUITE 140
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7110
Practice Address - Country:US
Practice Address - Phone:303-432-8487
Practice Address - Fax:303-536-1854
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0002451235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist