Individual
KATIE LYNN PROVORSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
113 N COURT ST, BUENA VISTA, CO 81211-2027
(719) 395-7054
Mailing address
10335 PIUTE DR, SALIDA, CO 81201-8515
(719) 207-1054
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
PSLP.0000204
CO
Other
Enumeration date
02/19/2017
Last updated
10/05/2023
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