Provider Demographics
NPI:1730798638
Name:HEARNE, GEORGIANNA
Entity type:Individual
Prefix:
First Name:GEORGIANNA
Middle Name:
Last Name:HEARNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GEORGIANNA
Other - Middle Name:
Other - Last Name:WALPOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3059 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2509
Mailing Address - Country:US
Mailing Address - Phone:303-443-5085
Mailing Address - Fax:
Practice Address - Street 1:3059 WALNUT ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2509
Practice Address - Country:US
Practice Address - Phone:303-443-5085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD0001033231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist