Healthcare Provider Details

I. General information

NPI: 1205215662
Provider Name (Legal Business Name): BOULDER COGNITIVE AND LINGUISTIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4251 KIPLING ST UNIT 405
WHEAT RIDGE CO
80033-6833
US

IV. Provider business mailing address

4251 KIPLING ST UNIT 405
WHEAT RIDGE CO
80033-6833
US

V. Phone/Fax

Practice location:
  • Phone: 303-932-2030
  • Fax:
Mailing address:
  • Phone: 303-932-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP.0002016
License Number StateCO

VIII. Authorized Official

Name: SARAH BRITTAIN
Title or Position: PRESIDENT
Credential: M.S. CCC SLP
Phone: 303-932-2030