Healthcare Provider Details

I. General information

NPI: 1528787793
Provider Name (Legal Business Name): PEDIATRIC SPEECH THERAPY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12110 PECOS ST STE 250
WESTMINSTER CO
80234-2047
US

IV. Provider business mailing address

6851 S HOLLY CIR STE 295
CENTENNIAL CO
80112-1019
US

V. Phone/Fax

Practice location:
  • Phone: 720-542-8737
  • Fax: 720-242-8085
Mailing address:
  • Phone: 720-542-8737
  • Fax: 720-242-8085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: BRYAN SHEPHERD
Title or Position: PRESIDENT
Credential:
Phone: 720-542-8737