Provider Demographics
NPI:1790269363
Name:KACZMAREK, ABBY ELIZABETH (CCC- SLP)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:ELIZABETH
Last Name:KACZMAREK
Suffix:
Gender:F
Credentials:CCC- SLP
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:ELIZABETH
Other - Last Name:GREENHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4850 S YOSEMITE ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4850 S YOSEMITE ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1308
Practice Address - Country:US
Practice Address - Phone:720-848-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0003294235Z00000X
14132421235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COSLP.0003294Other235Z00000X