Healthcare Provider Details

I. General information

NPI: 1235615972
Provider Name (Legal Business Name): SPEECH, LANGUAGE AND LISTENING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 DEPEW ST
WHEAT RIDGE CO
80214
US

IV. Provider business mailing address

3002 DEPEW ST
WHEAT RIDGE CO
80214-8448
US

V. Phone/Fax

Practice location:
  • Phone: 303-548-7666
  • Fax:
Mailing address:
  • Phone: 303-548-7666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP.0001447
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberSLP.0001447
License Number StateCO

VIII. Authorized Official

Name: CHRISTINA PATTERSON
Title or Position: SOLE PROPRIETOR/SLP
Credential:
Phone: 303-548-7666