Healthcare Provider Details

I. General information

NPI: 1518580810
Provider Name (Legal Business Name): INDIGO SPEECH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6750 E CHENANGO AVE APT 693
DENVER CO
80237-3186
US

IV. Provider business mailing address

6750 E CHENANGO AVE APT 693
DENVER CO
80237-3186
US

V. Phone/Fax

Practice location:
  • Phone: 786-536-0040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA3000X
TaxonomyAugmentative Communication Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ESTEFANIA ROMERA
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: M.S., CCC - SLP
Phone: 786-536-0040