Provider Demographics
NPI:1487786406
Name:CICHON, RENEE HADAD (AUD)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:HADAD
Last Name:CICHON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3595 E SPAULDING AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2208
Mailing Address - Country:US
Mailing Address - Phone:719-544-3828
Mailing Address - Fax:719-544-3138
Practice Address - Street 1:3595 E SPAULDING AVE STE A
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2208
Practice Address - Country:US
Practice Address - Phone:719-544-3828
Practice Address - Fax:719-544-3138
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO316231HA2400X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO40165Medicaid
CO412139979Medicare UPIN
CO544258Medicare ID - Type UnspecifiedGROUP
CO544278Medicare ID - Type UnspecifiedINDIVIDUAL