Healthcare Provider Details

I. General information

NPI: 1245094515
Provider Name (Legal Business Name): FIREFLY PEDIATRIC THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9205 IRONWOOD WAY
HIGHLANDS RANCH CO
80129-6431
US

IV. Provider business mailing address

9205 IRONWOOD WAY
HIGHLANDS RANCH CO
80129-6431
US

V. Phone/Fax

Practice location:
  • Phone: 817-909-3948
  • Fax:
Mailing address:
  • Phone: 817-909-3948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RANDA AVANCE
Title or Position: OWNER
Credential: MS CCC-SLP; IBCLC
Phone: 817-909-3948