Provider Demographics
NPI:1730152570
Name:HALLIGAN, KELLY MARIE (AUD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MARIE
Last Name:HALLIGAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:HALLIGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 1295
Mailing Address - Street 2:
Mailing Address - City:FAIRPLAY
Mailing Address - State:CO
Mailing Address - Zip Code:80440-1295
Mailing Address - Country:US
Mailing Address - Phone:719-838-0328
Mailing Address - Fax:719-836-4874
Practice Address - Street 1:620 MAIN ST
Practice Address - Street 2:102
Practice Address - City:FAIRPLAY
Practice Address - State:CO
Practice Address - Zip Code:80440-1295
Practice Address - Country:US
Practice Address - Phone:719-838-0328
Practice Address - Fax:719-836-4874
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD20231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47821230Medicaid
CO800197Medicare UPIN
CO47821230Medicaid