Provider Demographics
NPI:1134621162
Name:LAVERTY, HOLLIS (MA-CCC,SLP)
Entity type:Individual
Prefix:
First Name:HOLLIS
Middle Name:
Last Name:LAVERTY
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 1:4271 LOWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-1656
Mailing Address - Country:US
Mailing Address - Phone:720-201-2172
Mailing Address - Fax:
Practice Address - Street 1:4271 LOWELL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-1656
Practice Address - Country:US
Practice Address - Phone:303-996-6510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12081106235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$OtherSOCIAL SECURITY