MEDICARE: INDIGO SPEECH THERAPY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QA3000X	Augmentative Communication Clinic/Center
2	261QD1600X	Developmental Disabilities Clinic/Center
3	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1518580810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIGO SPEECH THERAPY LLC

Provider Business Mailing Address
First Line	:	6750 E CHENANGO AVE APT 693
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80237-3186
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6750 E CHENANGO AVE APT 693
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80237-3186
Country	:	US
Telephone Number	:	786-536-0040
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	ESTEFANIA ROMERA
Credential	:	M.S., CCC - SLP
Telephone Number	:	786-536-0040

Provider Enumeration Date	:	05/20/2020
Last Update Date	:	05/20/2020

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Directions to “INDIGO SPEECH THERAPY LLC ” Practice Location

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