Provider Demographics
NPI:1962832634
Name:CHISHOLM, DEVON (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 MITCHELL WAY STE 117
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-5444
Mailing Address - Country:US
Mailing Address - Phone:303-579-8098
Mailing Address - Fax:
Practice Address - Street 1:134 JACKSON DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-3643
Practice Address - Country:US
Practice Address - Phone:303-827-4368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001197235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist