Provider Demographics
NPI:1750609749
Name:NELSON, EMILY B (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:B
Last Name:NELSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4467 KING ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-1325
Mailing Address - Country:US
Mailing Address - Phone:720-763-3245
Mailing Address - Fax:720-302-1185
Practice Address - Street 1:4045 WADSWORTH BLVD STE 210
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4624
Practice Address - Country:US
Practice Address - Phone:720-633-4528
Practice Address - Fax:720-302-1185
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2977235Z00000X
COSLP.0000819235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO543094ZXGHOtherMEDICARE B COLORADO
KSKA4321001OtherMEDICARE B KANSAS
KSKA4321001OtherMEDICARE B KANSAS