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General NPI Number Information
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NPI Number | 1326531716
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Entity Type | Organization
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Legal Business Name | MESA DEVELOPMENTAL SERVICES
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 950 GRAND AVE
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City | GRAND JUNCTION
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State | CO
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Zip | 81501
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Country | US
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Telephone | 970-256-8637
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Fax |
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Provider Business Mailing Address
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Address Line | 950 GRAND AVE
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-3451
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ACCOUNTANT
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Name | MICHELE A BURNS
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Credential |
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Telephone | 970-256-8637
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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 | OT.0002450
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License Number State | CO
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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 | SLP.0001244
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY.0003377
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License Number State | CO
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