Healthcare Provider Details

I. General information

NPI: 1144818964
Provider Name (Legal Business Name): CONNECT SPEECH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1981 DOUBLE EAGLE DR STE A
SHERIDAN WY
82801-2132
US

IV. Provider business mailing address

13 CHUKKAR LN
SHERIDAN WY
82801-9506
US

V. Phone/Fax

Practice location:
  • Phone: 307-429-0837
  • Fax:
Mailing address:
  • Phone: 307-751-3016
  • 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 Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHELSEA PAULUS
Title or Position: OWNER
Credential: MS, CCC-SLP
Phone: 307-429-0837