Provider Demographics
NPI:1114266335
Name:COLORADO CENTER FOR STUTTERING THERAPY
Entity Type:Organization
Organization Name:COLORADO CENTER FOR STUTTERING THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:MACCCSLP BRS FD
Authorized Official - Phone:303-722-0712
Mailing Address - Street 1:2696 S COLORADO BLVD
Mailing Address - Street 2:#345
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-5945
Mailing Address - Country:US
Mailing Address - Phone:303-722-0712
Mailing Address - Fax:303-722-0712
Practice Address - Street 1:2696 S COLORADO BLVD
Practice Address - Street 2:#345
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5945
Practice Address - Country:US
Practice Address - Phone:303-722-0712
Practice Address - Fax:303-722-0712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONONE REQUIRED235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty