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General NPI Number Information
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NPI Number | 1871046524
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Entity Type | Organization
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Legal Business Name | ALLY SPEECH THERAPY, LLC
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Dates
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Enumeration Date | 07/29/2016
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Last Update Date | 07/29/2016
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Provider Practice Location Address
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Address Line | 200 UNION BLVD SUITE 200
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City | LAKEWOOD
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State | CO
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Zip | 80228-1830
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Country | US
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Telephone | 720-556-1225
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Fax |
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Provider Business Mailing Address
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Address Line | 12217 W NEW MEXICO PL
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City | LAKEWOOD
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State | CO
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Zip | 80228-3934
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Country | US
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Telephone | 720-556-1225
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | TRACI FLANNERY
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Credential | SLP
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Telephone | 720-556-1225
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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 | 20161419737
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License Number State | CO
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