Provider Demographics
NPI:1316483498
Name:TURNER-VILLALAZ, STACY (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:TURNER-VILLALAZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 DARLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-6028
Mailing Address - Country:US
Mailing Address - Phone:303-929-5937
Mailing Address - Fax:
Practice Address - Street 1:8401 ARISTA PL
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-4154
Practice Address - Country:US
Practice Address - Phone:720-777-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0001279235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist