Provider Demographics
NPI:1982411641
Name:KUESTER, ANNALISE (MA SLP-CCC)
Entity type:Individual
Prefix:
First Name:ANNALISE
Middle Name:
Last Name:KUESTER
Suffix:
Gender:X
Credentials:MA SLP-CCC
Other - Prefix:
Other - First Name:LISI
Other - Middle Name:
Other - Last Name:KUESTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA SLP-CCC
Mailing Address - Street 1:1895 ALPINE AVE APT I35
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3674
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1950 MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-9865
Practice Address - Country:US
Practice Address - Phone:303-651-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0006154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist