Provider Demographics
NPI:1760962583
Name:ECKHARDT, MICAH ANN (MS SLP-CCC)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:ANN
Last Name:ECKHARDT
Suffix:
Gender:F
Credentials:MS SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 E PROSPECT RD STE 4
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-9768
Mailing Address - Country:US
Mailing Address - Phone:970-305-4730
Mailing Address - Fax:
Practice Address - Street 1:2290 E PROSPECT RD STE 4
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-9768
Practice Address - Country:US
Practice Address - Phone:970-305-4730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist