Healthcare Provider Details

I. General information

NPI: 1609319250
Provider Name (Legal Business Name): STEP BY STEP PEDIATRIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1096 MILO CIR UNIT A
LAFAYETTE CO
80026-3084
US

IV. Provider business mailing address

1096 MILO CIR UNIT A
LAFAYETTE CO
80026-3084
US

V. Phone/Fax

Practice location:
  • Phone: 312-835-6665
  • Fax:
Mailing address:
  • Phone: 720-453-0733
  • Fax: 720-360-0624

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 Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MANDY LEE SANGHA
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MA, CCC-SLP
Phone: 720-453-0733