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General NPI Number Information
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NPI Number | 1598399891
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Entity Type | Organization
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Legal Business Name | PICKETT SPEECH THERAPY
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Dates
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Enumeration Date | 02/25/2020
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 4150 JULESBERG DR
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City | LOVELAND
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State | CO
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Zip | 80538-6137
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Country | US
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Telephone | 435-764-7461
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Fax |
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Provider Business Mailing Address
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Address Line | 4150 JULESBERG DR
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City | LOVELAND
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State | CO
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Zip | 80538-6137
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Country | US
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Telephone | 435-764-7461
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | KRISTINA PICKETT
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Credential | M.S., CCC-SLP
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Telephone | 435-764-7461
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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 |
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License Number State |
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