Healthcare Provider Details

I. General information

NPI: 1699603225
Provider Name (Legal Business Name): GRAND ADVENTURES THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2813 SECCOMB ST
FORT COLLINS CO
80526-6211
US

IV. Provider business mailing address

4333 CORBETT DR # 1039
FORT COLLINS CO
80525-6111
US

V. Phone/Fax

Practice location:
  • Phone: 970-239-1316
  • Fax:
Mailing address:
  • Phone: 970-239-1316
  • 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: KRISTINE AMY ELMORE
Title or Position: OWNER
Credential: M.S., SLP
Phone: 970-239-1316