Provider Demographics
NPI:1639159429
Name:NEL, MARY LYNN (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:NEL
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 TAFT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8307
Mailing Address - Country:US
Mailing Address - Phone:970-412-6394
Mailing Address - Fax:970-663-3227
Practice Address - Street 1:3001 TAFT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8307
Practice Address - Country:US
Practice Address - Phone:970-412-6394
Practice Address - Fax:970-663-3227
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84585072Medicaid