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General NPI Number Information
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NPI Number | 1558877167
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Entity Type | Organization
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Legal Business Name | MIGHTY MOUTH LLC
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Dates
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Enumeration Date | 12/19/2017
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Last Update Date | 12/19/2017
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Provider Practice Location Address
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Address Line | 6086 S ALTON WAY
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-5223
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Country | US
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Telephone | 720-933-7447
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Fax |
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Provider Business Mailing Address
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Address Line | 6086 S ALTON WAY
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-5223
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Country | US
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Telephone | 720-933-7447
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUSANA DUGAS
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Credential | MA, CCC-SLP
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Telephone | 720-933-7447
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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 | 01096989
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License Number State | CO
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