Provider Demographics
NPI:1275080236
Name:FASMAN, KAELA (AUD)
Entity Type:Individual
Prefix:
First Name:KAELA
Middle Name:
Last Name:FASMAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12001 TEJON ST
Mailing Address - Street 2:SUITE 124
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2310
Mailing Address - Country:US
Mailing Address - Phone:720-486-0171
Mailing Address - Fax:
Practice Address - Street 1:12001 TEJON ST
Practice Address - Street 2:SUITE 124
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2310
Practice Address - Country:US
Practice Address - Phone:720-486-0171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000816231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist