Healthcare Provider Details

I. General information

NPI: 1699482851
Provider Name (Legal Business Name): TALK AND PLAY THERAPIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 FORTINO BLVD STE D
PUEBLO CO
81008-2076
US

IV. Provider business mailing address

1310 FORTINO BLVD STE D
PUEBLO CO
81008-2076
US

V. Phone/Fax

Practice location:
  • Phone: 719-251-0935
  • Fax:
Mailing address:
  • Phone: 719-251-0935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MEGAN BETTS
Title or Position: SPEECH LANGUAGE PATHOLOGIST/MEMBER
Credential:
Phone: 719-251-0935