Provider Demographics
NPI:1023132081
Name:DOOLITTLE, KELLY SUZANNE (MA)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:SUZANNE
Last Name:DOOLITTLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19729 WELD COUNTY ROAD 25 1/2
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80651-8908
Mailing Address - Country:US
Mailing Address - Phone:970-737-2425
Mailing Address - Fax:
Practice Address - Street 1:19729 WELD COUNTY ROAD 25.5
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:CO
Practice Address - Zip Code:80651-8908
Practice Address - Country:US
Practice Address - Phone:970-737-2425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1234231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16550234Medicaid