Provider Demographics
NPI:1881964401
Name:NORTHFORK SPEECH & HEARING PC
Entity type:Organization
Organization Name:NORTHFORK SPEECH & HEARING PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ARCHIE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:307-322-3332
Mailing Address - Street 1:373 W DRAKE RD STE 5A
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2832
Mailing Address - Country:US
Mailing Address - Phone:970-449-4110
Mailing Address - Fax:970-449-4119
Practice Address - Street 1:373 W DRAKE RD STE 5A
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2832
Practice Address - Country:US
Practice Address - Phone:970-449-4110
Practice Address - Fax:970-449-4119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO578231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty