Provider Demographics
NPI:1265927933
Name:DEVOTTO, LYNSI ELISE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LYNSI
Middle Name:ELISE
Last Name:DEVOTTO
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 1:833 LEGEND OAK DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-4664
Mailing Address - Country:US
Mailing Address - Phone:719-250-7380
Mailing Address - Fax:
Practice Address - Street 1:1775 LACLEDE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-9502
Practice Address - Country:US
Practice Address - Phone:719-327-2820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2024-01-29
Deactivation Date:2023-12-07
Deactivation Code:
Reactivation Date:2024-01-26
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CO14486005235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician