Provider Demographics
NPI:1619464625
Name:BUJENOVIC, ELIZABETH MALLORY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MALLORY
Last Name:BUJENOVIC
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MALLORY
Other - Last Name:NUGENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:3311 N HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3935
Mailing Address - Country:US
Mailing Address - Phone:419-708-9047
Mailing Address - Fax:
Practice Address - Street 1:8501 TURNPIKE DR UNIT 100
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-7042
Practice Address - Country:US
Practice Address - Phone:303-430-2390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235Z00000X235Z00000X
CO0005913235Z00000X
ND235Z00000X235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty