Provider Demographics
NPI:1538717533
Name:BOGARDUS, KRISTIN ITO
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ITO
Last Name:BOGARDUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1472 S PIERSON CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-4930
Mailing Address - Country:US
Mailing Address - Phone:303-335-8466
Mailing Address - Fax:
Practice Address - Street 1:1472 S PIERSON CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-4930
Practice Address - Country:US
Practice Address - Phone:303-335-8466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist