Healthcare Provider Details

I. General information

NPI: 1306462965
Provider Name (Legal Business Name): CRESENTE MENTES A LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1692 W CANAL CIR UNIT 1034
LITTLETON CO
80120-4560
US

IV. Provider business mailing address

1692 W CANAL CIR UNIT 1034
LITTLETON CO
80120-4560
US

V. Phone/Fax

Practice location:
  • Phone: 720-429-4052
  • Fax:
Mailing address:
  • Phone: 720-429-4052
  • 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 Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERESA LYNN CASE
Title or Position: DIRECTOR
Credential: SLP
Phone: 720-429-4052