Provider Demographics
NPI:1750455341
Name:MCDERMOTT, STEVEN J (AUD CCC A)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:AUD CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 BOOKCLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8107
Mailing Address - Country:US
Mailing Address - Phone:970-812-3989
Mailing Address - Fax:970-514-5468
Practice Address - Street 1:725 BOOKCLIFF AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8107
Practice Address - Country:US
Practice Address - Phone:970-812-3989
Practice Address - Fax:970-514-5468
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO384231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41873033Medicaid