Provider Demographics
NPI:1780964049
Name:MCNULTY, STACEY ERIN
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:ERIN
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W HAMPDEN PL STE 240
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2471
Mailing Address - Country:US
Mailing Address - Phone:303-788-7880
Mailing Address - Fax:303-788-7883
Practice Address - Street 1:401 W HAMPDEN PL STE 240
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2471
Practice Address - Country:US
Practice Address - Phone:303-788-7880
Practice Address - Fax:303-788-7883
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000595231H00000X
CO738231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist