MEDICARE: MOXIE 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	:	1538946264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOXIE SPEECH THERAPY LLC

Provider Business Mailing Address
First Line	:	8758 E 24TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-2921
Country	:	US
Telephone Number	:	303-324-5435
Fax Number	:

Provider Business Practice Location Address
First Line	:	8758 E 24TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-2921
Country	:	US
Telephone Number	:	303-324-5435
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SUSAN JUNE DOHERTY
Credential	:	MA, CCC-SLP
Telephone Number	:	303-324-5435

Provider Enumeration Date	:	09/14/2023
Last Update Date	:	09/14/2023

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Directions to “MOXIE SPEECH THERAPY LLC ” Practice Location

Language	Start Address	Practice Location

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