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General NPI Number Information
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NPI Number | 1629252952
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Entity Type | Organization
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Legal Business Name | GROWING EXPERIENTIALLY MULTI-DISCIPLINARY SERVICE
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 12/21/2007
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Provider Practice Location Address
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Address Line | 3443 S GALENA ST STE. 255
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City | DENVER
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State | CO
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Zip | 80231-5079
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Country | US
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Telephone | 303-752-2977
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Fax | 303-752-2971
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Provider Business Mailing Address
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Address Line | 3443 S GALENA ST STE. 255
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City | DENVER
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State | CO
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Zip | 80231-5079
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Country | US
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Telephone | 303-752-2977
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Fax | 303-752-2971
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KENT VADELIUS
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Credential |
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Telephone | 303-752-2977
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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 | CO
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Taxonomy #2
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State | CO
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