Provider Demographics
NPI:1033810437
Name:PURPLE MOUNTAIN SPEECH CLINIC, LLC.
Entity Type:Organization
Organization Name:PURPLE MOUNTAIN SPEECH CLINIC, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HEACOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-204-5236
Mailing Address - Street 1:6985 CABRIOLET DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-8797
Mailing Address - Country:US
Mailing Address - Phone:719-204-5236
Mailing Address - Fax:
Practice Address - Street 1:6985 CABRIOLET DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-8797
Practice Address - Country:US
Practice Address - Phone:719-204-5236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty