Provider Demographics
NPI:1134226186
Name:SCHACHTERLE, BRUCE D (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:D
Last Name:SCHACHTERLE
Suffix:
Gender:M
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8210 S ALBION ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-3903
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1550 S POTOMAC ST STE 305
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5433
Practice Address - Country:US
Practice Address - Phone:303-369-1096
Practice Address - Fax:303-369-1097
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07294093Medicaid
COC1793Medicare PIN