Provider Demographics
NPI:1821226630
Name:NORRIS, MANDY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:NORRIS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7085 W COUNTY ROAD 24
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9449
Mailing Address - Country:US
Mailing Address - Phone:940-206-1293
Mailing Address - Fax:
Practice Address - Street 1:365 E 41ST CT
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4815
Practice Address - Country:US
Practice Address - Phone:940-206-1293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103722235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist