Provider Demographics
NPI:1912574393
Name:CHIDESTER, KATJA
Entity Type:Individual
Prefix:
First Name:KATJA
Middle Name:
Last Name:CHIDESTER
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 1:8671 E 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3636
Mailing Address - Country:US
Mailing Address - Phone:720-362-9161
Mailing Address - Fax:
Practice Address - Street 1:8671 E 47TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3636
Practice Address - Country:US
Practice Address - Phone:720-362-9161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-05
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSLP.0000769235Z00000X
COSLP.0005019235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist