Provider Demographics
NPI:1205215662
Name:BOULDER COGNITIVE AND LINGUISTIC CENTER INC
Entity Type:Organization
Organization Name:BOULDER COGNITIVE AND LINGUISTIC CENTER INC
Other - Org Name:COLORADO CONCUSSION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:303-932-2030
Mailing Address - Street 1:4251 KIPLING ST UNIT 405
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6833
Mailing Address - Country:US
Mailing Address - Phone:303-932-2030
Mailing Address - Fax:
Practice Address - Street 1:4251 KIPLING ST UNIT 405
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6833
Practice Address - Country:US
Practice Address - Phone:303-932-2030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2081P0301X
COSLP.0002016235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury MedicineGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty