Provider Demographics
NPI:1467060723
Name:KLOACK, CARLY (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:KLOACK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10038 E 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-4373
Mailing Address - Country:US
Mailing Address - Phone:303-731-5125
Mailing Address - Fax:
Practice Address - Street 1:10038 E 62ND AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-4373
Practice Address - Country:US
Practice Address - Phone:303-731-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist