Provider Demographics
NPI:1528171337
Name:LUJAN, TARA M (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:M
Last Name:LUJAN
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 1:25100 E BELLEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5969
Mailing Address - Country:US
Mailing Address - Phone:720-886-6926
Mailing Address - Fax:
Practice Address - Street 1:25100 E BELLEVIEW AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5969
Practice Address - Country:US
Practice Address - Phone:720-886-6926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17886546Medicaid