Provider Demographics
NPI:1538838016
Name:ROLDAN, KATHLEEN ANN (MS)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8641 GATEWICK DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7392
Mailing Address - Country:US
Mailing Address - Phone:719-330-5883
Mailing Address - Fax:
Practice Address - Street 1:8641 GATEWICK DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7392
Practice Address - Country:US
Practice Address - Phone:719-330-5883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP0000103235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist