Provider Demographics
NPI:1215055025
Name:BAZIL, CONNIE (AUD, PSYD)
Entity type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:
Last Name:BAZIL
Suffix:
Gender:F
Credentials:AUD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5835 CANYON RESERVE HEIGHTS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919
Mailing Address - Country:US
Mailing Address - Phone:719-351-8004
Mailing Address - Fax:
Practice Address - Street 1:179 S PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3130
Practice Address - Country:US
Practice Address - Phone:719-492-2114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO517231H00000X
CO13701101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist