Healthcare Provider Details

I. General information

NPI: 1538946264
Provider Name (Legal Business Name): MOXIE SPEECH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8758 E 24TH AVE
DENVER CO
80238-2921
US

IV. Provider business mailing address

8758 E 24TH AVE
DENVER CO
80238-2921
US

V. Phone/Fax

Practice location:
  • Phone: 303-324-5435
  • Fax:
Mailing address:
  • Phone: 303-324-5435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: SUSAN JUNE DOHERTY
Title or Position: OWNER
Credential: MA, CCC-SLP
Phone: 303-324-5435