Healthcare Provider Details

I. General information

NPI: 1518649870
Provider Name (Legal Business Name): TRAILBLAZER SPEECH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30752 SOUTHVIEW DR STE 200
EVERGREEN CO
80439-2221
US

IV. Provider business mailing address

30752 SOUTHVIEW DR STE 200
EVERGREEN CO
80439-2221
US

V. Phone/Fax

Practice location:
  • Phone: 720-765-5972
  • Fax: 972-444-6033
Mailing address:
  • Phone: 720-765-5972
  • Fax: 972-444-6033

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: MELINDA ROGERS
Title or Position: OWNER
Credential: CCC-SLP
Phone: 720-765-5972