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General NPI Number Information
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NPI Number | 1730609165
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Entity Type | Organization
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Legal Business Name | ICAN PLAY, LLC
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Dates
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Enumeration Date | 06/27/2017
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Last Update Date | 06/27/2017
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Provider Practice Location Address
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Address Line | 3451 S ELM ST
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City | DENVER
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State | CO
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Zip | 80222-7314
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Country | US
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Telephone | 19134390524
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Fax |
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Provider Business Mailing Address
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Address Line | 3451 S ELM ST
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City | DENVER
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State | CO
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Zip | 80222-7314
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Country | US
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Telephone | 19134390524
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST/CO-OWNE
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Name | JENNIFER RIAT
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Credential | MA, CCC-SLP
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Telephone | 913-439-0524
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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 | SLP.0001910
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 52439
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 52439
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License Number State | CO
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