Provider Demographics
NPI:1811001969
Name:CIVIELLO, AMY S (MACCC-A,FAAA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:CIVIELLO
Suffix:
Gender:F
Credentials:MACCC-A,FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 UNION BLVD
Mailing Address - Street 2:SUITE 421
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1830
Mailing Address - Country:US
Mailing Address - Phone:720-446-2828
Mailing Address - Fax:720-446-0941
Practice Address - Street 1:200 UNION BLVD
Practice Address - Street 2:SUITE 421
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1830
Practice Address - Country:US
Practice Address - Phone:720-446-2828
Practice Address - Fax:720-446-0941
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO218231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29451281Medicaid
CO454498Medicare ID - Type UnspecifiedGROUP NUMBER