Provider Demographics
NPI:1851449227
Name:FRY, ELIZABETH A (MS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:FRY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 S HOLLY ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-4022
Mailing Address - Country:US
Mailing Address - Phone:303-779-5869
Mailing Address - Fax:
Practice Address - Street 1:9218 KIMMER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6732
Practice Address - Country:US
Practice Address - Phone:303-792-7377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist