Provider Demographics
NPI:1508682170
Name:ELIZABETH DIERSCHOW
Entity type:Organization
Organization Name:ELIZABETH DIERSCHOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DIERSCHOW
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:303-725-6949
Mailing Address - Street 1:451 S OTIS ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3443
Mailing Address - Country:US
Mailing Address - Phone:303-725-6949
Mailing Address - Fax:
Practice Address - Street 1:451 S OTIS ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3443
Practice Address - Country:US
Practice Address - Phone:303-725-6949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELIZABETH DIERSCHOW
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-28
Last Update Date:2024-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech