Basic Information
| Provider Information | |||||||||
| NPI: | 1245807833 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CEGELSKE | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | AUDIOLOGIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2643 PATTERSON RD STE 503 | ||||||||
| Address2: | |||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815061937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702452400 | ||||||||
| FaxNumber: | 9702429092 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 TESSITORE CT UNIT B | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814015689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707874710 | ||||||||
| FaxNumber: | 9706157007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2021 | ||||||||
| LastUpdateDate: | 06/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AUD.0001081 | CO | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.