Provider Demographics
NPI:1659657211
Name:DUERSON, CAELI M
Entity Type:Individual
Prefix:
First Name:CAELI
Middle Name:M
Last Name:DUERSON
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 1:7000 BROADWAY STE 208
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-2909
Mailing Address - Country:US
Mailing Address - Phone:303-327-9738
Mailing Address - Fax:
Practice Address - Street 1:7000 BROADWAY STE 208
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-2909
Practice Address - Country:US
Practice Address - Phone:303-327-9738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002497235Z00000X
WI3525-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1659657211Medicaid
WIPENDING APPLICATIONMedicaid