Provider Demographics
NPI:1609399443
Name:KOLB, STACEY CAITLIN (AUD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:CAITLIN
Last Name:KOLB
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4451
Mailing Address - Fax:970-490-4199
Practice Address - Street 1:100 COOK ST STE 304
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5339
Practice Address - Country:US
Practice Address - Phone:720-516-9407
Practice Address - Fax:720-516-9435
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU3206231H00000X
CO231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist