Provider Demographics
NPI:1528618428
Name:LONGS PEAK AUDIOLOGY, LLC
Entity type:Organization
Organization Name:LONGS PEAK AUDIOLOGY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:MATHISEN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:303-263-6705
Mailing Address - Street 1:3100 REMINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2602
Mailing Address - Country:US
Mailing Address - Phone:970-266-8380
Mailing Address - Fax:
Practice Address - Street 1:3100 REMINGTON ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2602
Practice Address - Country:US
Practice Address - Phone:970-266-8380
Practice Address - Fax:303-857-6689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-13
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Multi-Specialty
No332S00000XSuppliersHearing Aid Equipment