Provider Demographics
NPI:1548038326
Name:HEROLD, ANNELISA CLARE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANNELISA
Middle Name:CLARE
Last Name:HEROLD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 KECHTER RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-9543
Mailing Address - Country:US
Mailing Address - Phone:970-488-5148
Mailing Address - Fax:
Practice Address - Street 1:3715 KECHTER RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-9543
Practice Address - Country:US
Practice Address - Phone:970-488-5148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24415831235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist