Provider Demographics
NPI:1891335550
Name:SELENSKY, NICOLETTE R
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:R
Last Name:SELENSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7514 ROBINSON WAY
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-5456
Mailing Address - Country:US
Mailing Address - Phone:406-546-3495
Mailing Address - Fax:
Practice Address - Street 1:400 W SOUTH BOULDER RD STE 2500
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2724
Practice Address - Country:US
Practice Address - Phone:720-515-4487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0003834235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist