Provider Demographics
NPI:1811981665
Name:NELSON, ALICIA NOELLE (CCC-A)
Entity type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:NOELLE
Last Name:NELSON
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:NOELLE
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:175 S UNION BLVD STE 200A
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3113
Mailing Address - Country:US
Mailing Address - Phone:719-203-5187
Mailing Address - Fax:
Practice Address - Street 1:175 S UNION BLVD STE 200A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3113
Practice Address - Country:US
Practice Address - Phone:719-203-5187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000992231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVAD000Medicare UPIN