Provider Demographics
NPI:1376371302
Name:GAUSMAN, EMMA GRACE (PSLP)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:GRACE
Last Name:GAUSMAN
Suffix:
Gender:F
Credentials:PSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 LAWRENCE ST UNIT 301
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2344
Mailing Address - Country:US
Mailing Address - Phone:812-363-2721
Mailing Address - Fax:
Practice Address - Street 1:10001 S OSWEGO ST
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3786
Practice Address - Country:US
Practice Address - Phone:720-763-8997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSLP.0001344390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program