Provider Demographics
NPI:1932375862
Name:AWAD, REBECCA SUZANNE NELSON (AUD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUZANNE NELSON
Last Name:AWAD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:13123 E 16TH AVE
Mailing Address - Street 2:B030
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7106
Mailing Address - Country:US
Mailing Address - Phone:720-777-6626
Mailing Address - Fax:720-777-7169
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:B030
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-6626
Practice Address - Fax:720-777-7169
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO520231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO31504078Medicaid