=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558786624
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TINY TALKERS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2014
-----------------------------------------------------
Last Update Date | 02/26/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21146 E CRESTLINE CIR
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80015-3633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-332-9498
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21146 E CRESTLINE CIR
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80015-3633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-332-9498
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH-LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | TARA M LUJAN
-----------------------------------------------------
Credential | M.A., CCC-SLP
-----------------------------------------------------
Telephone | 303-332-9498
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 0000489
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------