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General NPI Number Information
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NPI Number | 1831516285
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Entity Type | Organization
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Legal Business Name | TLC SPEECH THERAPY, INC
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Dates
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Enumeration Date | 03/24/2014
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Last Update Date | 03/24/2014
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Provider Practice Location Address
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Address Line | 626 GOLDEN EAGLE CIR
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City | GOLDEN
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State | CO
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Zip | 80401-0909
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Country | US
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Telephone | 303-883-2293
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Fax | 866-543-7981
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Provider Business Mailing Address
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Address Line | 626 GOLDEN EAGLE CIR
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City | GOLDEN
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State | CO
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Zip | 80401-0909
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Country | US
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Telephone | 303-883-2293
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Fax | 866-543-7981
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Authorized Official
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Title or Position | OWNER/SPEECH PATHOLOGIST
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Name | JOSI AMANDA WAGNER BERMANK
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Credential | M.S., CCC-SLP
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Telephone | 303-883-2293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 0000037
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License Number State | CO
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