=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538070545
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUMMIT THERAPY GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2026
-----------------------------------------------------
Last Update Date | 09/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5000 GOODMAN ST UNIT 105
-----------------------------------------------------
City | TIMNATH
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80547-2393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-900-6930
-----------------------------------------------------
Fax | 970-499-0576
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5000 GOODMAN ST UNIT 105
-----------------------------------------------------
City | TIMNATH
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80547-2393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-900-6930
-----------------------------------------------------
Fax | 970-449-0576
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JESSICA ELIZABETH HOGAN
-----------------------------------------------------
Credential | M.S CCC-SLP
-----------------------------------------------------
Telephone | 970-900-6930
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225A00000X
-----------------------------------------------------
Taxonomy Name | Music Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------