Healthcare Provider Details

I. General information

NPI: 1134490113
Provider Name (Legal Business Name): BRAIN FUNCTION OPTIMIZATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5562 RIM VIEW PL
PARKER CO
80134-4534
US

IV. Provider business mailing address

5562 RIM VIEW PL
PARKER CO
80134-4534
US

V. Phone/Fax

Practice location:
  • Phone: 303-522-9685
  • Fax:
Mailing address:
  • Phone: 303-522-9685
  • 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 Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number2307
License Number StateCO

VIII. Authorized Official

Name: MR. TORSTEN CHRISTOPH JESS
Title or Position: PRESIDENT
Credential: M.S.CCC-SLP.CS
Phone: 303-522-9685