Provider Demographics
NPI:1215640446
Name:VIANELLI-NIXON, STEPHANIE (MS SLP-CF)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:VIANELLI-NIXON
Suffix:
Gender:F
Credentials:MS SLP-CF
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:VIANELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5121 WILLIAMS FORK TRL
Mailing Address - Street 2:APT 205
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3455
Mailing Address - Country:US
Mailing Address - Phone:303-257-6808
Mailing Address - Fax:
Practice Address - Street 1:5121 WILLIAMS FORK TRL
Practice Address - Street 2:APT 205
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3455
Practice Address - Country:US
Practice Address - Phone:303-257-6808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSLP.0001074235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist