Provider Demographics
NPI:1164270187
Name:DUFFY, SEAN JOSEPH (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:JOSEPH
Last Name:DUFFY
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3344
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80437-3344
Mailing Address - Country:US
Mailing Address - Phone:814-777-3704
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 3344
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80437-3344
Practice Address - Country:US
Practice Address - Phone:814-777-3704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17058675235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist