Provider Demographics
NPI:1730450321
Name:SERAZIO, AUDREY SUSAN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:SUSAN
Last Name:SERAZIO
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 1:134 W. MAIN STE 12
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082
Mailing Address - Country:US
Mailing Address - Phone:719-846-4061
Mailing Address - Fax:719-846-4073
Practice Address - Street 1:134 W MAIN ST STE 12
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2600
Practice Address - Country:US
Practice Address - Phone:719-846-4061
Practice Address - Fax:719-846-4073
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist