Healthcare Provider Details

I. General information

NPI: 1508547076
Provider Name (Legal Business Name): LIFETIME SPEECH AND STUTTERING THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10996 LIVINGSTON DR
NORTHGLENN CO
80234-3384
US

IV. Provider business mailing address

10996 LIVINGSTON DR
NORTHGLENN CO
80234-3384
US

V. Phone/Fax

Practice location:
  • Phone: 512-790-0831
  • Fax: 303-219-2513
Mailing address:
  • Phone: 512-790-0831
  • Fax: 303-219-2513

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

VIII. Authorized Official

Name: WENDY DIETZ
Title or Position: OWNER, SPEECH-LANGUAGE PATHOLOGIST
Credential: M.S., CCC-SLP
Phone: 720-838-1346