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General NPI Number Information
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NPI Number | 1003230905
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Entity Type | Organization
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Legal Business Name | PICKY EATER'S ANONYMOUS LLC
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 135 NIAGARA ST
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City | DENVER
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State | CO
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Zip | 80220-6072
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Country | US
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Telephone | 585-750-6064
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Fax |
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Provider Business Mailing Address
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Address Line | 135 NIAGARA ST
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City | DENVER
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State | CO
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Zip | 80220-6072
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Country | US
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Telephone | 585-750-6064
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Fax |
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Authorized Official
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Title or Position | ONWER
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Name | HOLLY KNOTOWICZ
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Credential |
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Telephone | 585-750-6064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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