Provider Demographics
NPI:1396538658
Name:WOOTTON, MARLISA (AUD)
Entity type:Individual
Prefix:
First Name:MARLISA
Middle Name:
Last Name:WOOTTON
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 1:1315 VIVIAN ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3216
Mailing Address - Country:US
Mailing Address - Phone:303-776-8748
Mailing Address - Fax:303-684-9915
Practice Address - Street 1:4800 BASELINE RD STE E108
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2643
Practice Address - Country:US
Practice Address - Phone:303-499-3900
Practice Address - Fax:303-499-9506
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD.0001330231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist