Provider Demographics
NPI:1750778445
Name:CASON, KEVIN THOMAS (BC-HIS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:THOMAS
Last Name:CASON
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 E MAIN ST STE 8
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3064
Mailing Address - Country:US
Mailing Address - Phone:970-564-9088
Mailing Address - Fax:970-564-9042
Practice Address - Street 1:1740 E MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3064
Practice Address - Country:US
Practice Address - Phone:970-564-9088
Practice Address - Fax:970-564-9042
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO203237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist