Healthcare Provider Details

I. General information

NPI: 1518382878
Provider Name (Legal Business Name): SHOSHANA HERSKOVITS MA, SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4495 HALE PKWY
DENVER CO
80220-6210
US

IV. Provider business mailing address

8732 E GRAND AVE
DENVER CO
80237-2923
US

V. Phone/Fax

Practice location:
  • Phone: 844-757-7450
  • Fax:
Mailing address:
  • Phone: 732-300-1208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS00721300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP.0001890
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: