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General NPI Number Information
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NPI Number | 1205257490
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Entity Type | Organization
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Legal Business Name | SPEECH LANGUAGE THERAPY, LLC
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Dates
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Enumeration Date | 12/15/2013
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Last Update Date | 12/15/2013
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Provider Practice Location Address
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Address Line | 810 FLATIRONS CT
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City | LOUISVILLE
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State | CO
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Zip | 80027-3111
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Country | US
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Telephone | 720-254-6444
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Fax | 413-691-9444
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Provider Business Mailing Address
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Address Line | 810 FLATIRONS CT
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City | LOUISVILLE
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State | CO
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Zip | 80027-3111
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Country | US
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Telephone | 720-254-6444
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Fax | 413-691-9444
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Authorized Official
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Title or Position | OWNER
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Name | KRISTIN WHITE
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Credential | M.S./CCC-SLP
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Telephone | 720-254-6444
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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 | SLP.0000899
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License Number State | CO
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