Individual
MARY BACKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
403 SUMMIT BLVD STE 204B, BROOMFIELD, CO 80021-8252
(720) 401-2139
Mailing address
7100 NEW HOPE RD, GRANTS PASS, OR 97527-7921
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
0001251
CO
Other
Enumeration date
01/23/2024
Last updated
01/23/2024
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