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General NPI Number Information
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NPI Number | 1225419039
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Entity Type | Organization
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Legal Business Name | KIDS ONLINE THERAPY WORKS LLC
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Dates
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Enumeration Date | 06/17/2015
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 2824 SYRACUSE CT
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City | DENVER
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State | CO
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Zip | 80238-2454
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Country | US
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Telephone | 703-932-2099
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Fax | 303-474-3011
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Provider Business Mailing Address
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Address Line | 2824 SYRACUSE CT
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City | DENVER
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State | CO
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Zip | 80238-2454
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Country | US
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Telephone | 703-932-2099
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Fax | 303-474-3011
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | PATRICIA ANNE ROGERS
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Credential | M.A.CCC, SLP
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Telephone | 703-932-2099
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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 | SLP0001743
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License Number State | CO
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