Provider Demographics
NPI:1679735609
Name:POTTS, KEVIN DANE (AUD)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DANE
Last Name:POTTS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:POTTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,CCC-A
Mailing Address - Street 1:2060 BRIARGATE PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7699
Mailing Address - Country:US
Mailing Address - Phone:719-301-3800
Mailing Address - Fax:719-301-3855
Practice Address - Street 1:2060 BRIARGATE PKWY STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7699
Practice Address - Country:US
Practice Address - Phone:719-301-3800
Practice Address - Fax:719-301-3855
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD.0000846231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX51624OtherTEXAS LICENSE
01115630OtherASHA CERTIFICATION NUMBER