Provider Demographics
NPI:1134490113
Name:BRAIN FUNCTION OPTIMIZATION, LLC
Entity Type:Organization
Organization Name:BRAIN FUNCTION OPTIMIZATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TORSTEN
Authorized Official - Middle Name:CHRISTOPH
Authorized Official - Last Name:JESS
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCC-SLPCS
Authorized Official - Phone:303-522-9685
Mailing Address - Street 1:5562 RIM VIEW PL
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-4534
Mailing Address - Country:US
Mailing Address - Phone:303-522-9685
Mailing Address - Fax:
Practice Address - Street 1:5562 RIM VIEW PL
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-4534
Practice Address - Country:US
Practice Address - Phone:303-522-9685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
CO2307273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No273Y00000XHospital UnitsRehabilitation UnitGroup - Single Specialty