KATIE LYNN PROVORSE

BUENA VISTA, CO
NPI1568901841
Former NameKATIE LYNN PENA LUNA
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy235Z00000X Speech-Language Pathologist,
(Licence: CO  PSLP.0000204)
Enumeration Date2017-02-19
Last Update Date2023-10-05
Business Address
KATIE LYNN PROVORSE
113 N COURT ST
BUENA VISTA, CO 81211-2027
Phone number: 719-395-7054
Mailing Address
KATIE LYNN PROVORSE
10335 PIUTE DR
SALIDA, CO 81201-8515
Phone number: 719-207-1054
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