Provider Demographics
NPI:1043665011
Name:MUTCHNICK, NATHAN (SLP)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:MUTCHNICK
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17478 W 95TH AVE
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-8013
Mailing Address - Country:US
Mailing Address - Phone:248-229-0090
Mailing Address - Fax:
Practice Address - Street 1:17478 W 95TH AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-8013
Practice Address - Country:US
Practice Address - Phone:248-229-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2024-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14113707235Z00000X
MI14113707235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist