Provider Demographics
NPI:1629846746
Name:RICKLEFS, HALLY ALLENA
Entity Type:Individual
Prefix:
First Name:HALLY
Middle Name:ALLENA
Last Name:RICKLEFS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 N INSTITUTE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3508
Mailing Address - Country:US
Mailing Address - Phone:719-327-2843
Mailing Address - Fax:
Practice Address - Street 1:33 N INSTITUTE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3508
Practice Address - Country:US
Practice Address - Phone:719-327-2843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14380106235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist