Provider Demographics
NPI:1265061212
Name:FANUCCHI, ALICIA NICOLE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:NICOLE
Last Name:FANUCCHI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7180 E ORCHARD RD STE 103
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1725
Mailing Address - Country:US
Mailing Address - Phone:720-306-8261
Mailing Address - Fax:
Practice Address - Street 1:7180 E ORCHARD RD STE 103
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-1725
Practice Address - Country:US
Practice Address - Phone:720-306-8261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0003690235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist