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General NPI Number Information
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NPI Number | 1700651734
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Entity Type | Organization
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Legal Business Name | VOICE AND SWALLOW THERAPY CLINIC PROFESSIONAL COMPANY
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Dates
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Enumeration Date | 11/20/2023
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 5600 S QUEBEC ST STE 107A
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2201
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Country | US
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Telephone | 406-490-7310
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Fax |
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Provider Business Mailing Address
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Address Line | 474 BLACK FEATHER LOOP APT 420
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City | CASTLE ROCK
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State | CO
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Zip | 80104-8007
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Country | US
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Telephone | 406-490-7310
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARISSA LYNN LITTLE
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Credential | MS CCC-SLP
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Telephone | 406-490-7310
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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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