Basic Information
| Provider Information | |||||||||
| NPI: | 1053678441 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITCOMB | ||||||||
| FirstName: | STACY | ||||||||
| MiddleName: | MAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202 E CHEYENNE MOUNTAIN BLVD | ||||||||
| Address2: | SUITE L | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809063769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195388488 | ||||||||
| FaxNumber: | 7195388288 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 E CHEYENNE MOUNTAIN BLVD | ||||||||
| Address2: | SUITE L | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809063769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195388488 | ||||||||
| FaxNumber: | 7195388288 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2012 | ||||||||
| LastUpdateDate: | 04/23/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 191 | CO | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.