Basic Information
| Provider Information | |||||||||
| NPI: | 1407070212 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NORTHEY | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3575 S SHERMAN ST STE 3 | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801133798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037617600 | ||||||||
| FaxNumber: | 3037621053 | ||||||||
| Practice Location | |||||||||
| Address1: | 3575 S SHERMAN ST STE 3 | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801133798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037617600 | ||||||||
| FaxNumber: | 3037621053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 101 | CO | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | 101 | 01 | CO | STATE LICENSE | OTHER | 53251342 | 05 | CO | MEDICAID |