Provider Demographics
NPI:1487622767
Name:PHILLIPS, GLORIA NATALIE (AUD)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:NATALIE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:2001 S SHIELDS ST STE H102
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1727
Mailing Address - Country:US
Mailing Address - Phone:970-493-5334
Mailing Address - Fax:970-472-0638
Practice Address - Street 1:2001 S SHIELDS ST STE H102
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1727
Practice Address - Country:US
Practice Address - Phone:970-893-7621
Practice Address - Fax:970-893-7622
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO577231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00837014OtherRAILROAD MEDICARE
CO03075265Medicaid
COP00837014OtherRAILROAD MEDICARE