Provider Demographics
NPI:1154019933
Name:ARCHULETA, SAVANNAH RENE (HAD)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:RENE
Last Name:ARCHULETA
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 E HARMONY RD UNIT 350B
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3404
Mailing Address - Country:US
Mailing Address - Phone:970-484-6373
Mailing Address - Fax:970-484-0382
Practice Address - Street 1:2121 E HARMONY RD UNIT 350B
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3404
Practice Address - Country:US
Practice Address - Phone:970-484-6373
Practice Address - Fax:970-484-0382
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000505237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist