Provider Demographics
NPI:1447835541
Name:ISAACSON, AUDREY
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:ISAACSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 DELAWARE AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6169
Mailing Address - Country:US
Mailing Address - Phone:720-526-8102
Mailing Address - Fax:
Practice Address - Street 1:825 DELAWARE AVE STE 206
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6169
Practice Address - Country:US
Practice Address - Phone:720-526-8102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist