Provider Demographics
NPI:1457034837
Name:DICO, IRRAH MARIE TARIMAN (MA)
Entity Type:Individual
Prefix:MRS
First Name:IRRAH MARIE
Middle Name:TARIMAN
Last Name:DICO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:IRRAH MARIE
Other - Middle Name:BUGHAO
Other - Last Name:TARIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:2385 SAINT PAUL DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3204
Mailing Address - Country:US
Mailing Address - Phone:719-678-2011
Mailing Address - Fax:
Practice Address - Street 1:1060 HARRISON RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-3586
Practice Address - Country:US
Practice Address - Phone:719-579-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0004873235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist