Provider Demographics
NPI:1134571573
Name:CICHANTEK, KAROLYN MICHELLE (MS, SLP, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAROLYN
Middle Name:MICHELLE
Last Name:CICHANTEK
Suffix:
Gender:F
Credentials:MS, SLP, CCC-SLP
Other - Prefix:
Other - First Name:KAROLYN
Other - Middle Name:MICHELLE
Other - Last Name:MENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2822 PINNACLE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-1113
Mailing Address - Country:US
Mailing Address - Phone:303-518-0405
Mailing Address - Fax:
Practice Address - Street 1:7015 TALL OAK DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2513
Practice Address - Country:US
Practice Address - Phone:303-518-0405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0002989235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist