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General NPI Number Information
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NPI Number | 1528787793
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Entity Type | Organization
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Legal Business Name | PEDIATRIC SPEECH THERAPY ASSOCIATES
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 12110 PECOS ST STE 250
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City | WESTMINSTER
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State | CO
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Zip | 80234-2047
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Country | US
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Telephone | 720-542-8737
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Fax | 720-242-8085
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Provider Business Mailing Address
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Address Line | 6851 S HOLLY CIR STE 295
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City | CENTENNIAL
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State | CO
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Zip | 80112-1019
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Country | US
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Telephone | 720-542-8737
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Fax | 720-242-8085
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRYAN SHEPHERD
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Credential |
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Telephone | 720-542-8737
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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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