Provider Demographics
NPI:1720203110
Name:GAIGE, VIRGINIA MARY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MARY
Last Name:GAIGE
Suffix:
Gender:F
Credentials:MA, 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:PO BOX 3272
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80307-3272
Mailing Address - Country:US
Mailing Address - Phone:720-353-8405
Mailing Address - Fax:720-863-2197
Practice Address - Street 1:3041 PROMONTORY LOOP
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-8013
Practice Address - Country:US
Practice Address - Phone:720-353-8405
Practice Address - Fax:720-863-2197
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25682288Medicaid