Provider Demographics
NPI:1831633429
Name:SMALL, THERESA HILTON (AUD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:HILTON
Last Name:SMALL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9867 E PEAKVIEW AVE
Mailing Address - Street 2:APT E10
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5536
Mailing Address - Country:US
Mailing Address - Phone:303-741-2122
Mailing Address - Fax:970-346-8363
Practice Address - Street 1:9867 E PEAKVIEW AVE
Practice Address - Street 2:APT E10
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80111-5536
Practice Address - Country:US
Practice Address - Phone:303-741-2122
Practice Address - Fax:970-346-8363
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD287231H00000X
NVA1942231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist