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General NPI Number Information
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NPI Number | 1063396158
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Entity Type | Organization
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Legal Business Name | MINDFUL MOMENTS SPEECH THERAPY
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Dates
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Enumeration Date | 08/02/2025
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Last Update Date | 08/02/2025
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Provider Practice Location Address
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Address Line | 271 S ELM AVE STE 3AAND3B
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City | EATON
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State | CO
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Zip | 80615-8264
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Country | US
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Telephone | 419-206-6538
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Fax |
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Provider Business Mailing Address
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Address Line | 56444 COUNTY ROAD 23
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City | CARR
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State | CO
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Zip | 80612-9316
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Country | US
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Telephone | 419-206-6538
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAUREN PELTON
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Credential | SLP
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Telephone | 419-206-6538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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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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