MEDICARE: CHICKADEE SPEECH THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1508509043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICKADEE SPEECH THERAPY, LLC

Provider Business Mailing Address
First Line	:	1826 DEEP WOODS LN
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2370
Country	:	US
Telephone Number	:	727-560-8758
Fax Number	:

Provider Business Practice Location Address
First Line	:	1826 DEEP WOODS LN
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2370
Country	:	US
Telephone Number	:	727-560-8758
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JENNIFER MARIE NEALIS
Credential	:	SLP
Telephone Number	:	727-560-8758

Provider Enumeration Date	:	04/13/2022
Last Update Date	:	04/13/2022

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Directions to “CHICKADEE SPEECH THERAPY, LLC ” Practice Location

Language	Start Address	Practice Location

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