Provider Demographics
NPI:1285848051
Name:GREEN MOUNTAIN NEUROMONITORING LLC
Entity Type:Organization
Organization Name:GREEN MOUNTAIN NEUROMONITORING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRADBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:720-244-4498
Mailing Address - Street 1:3464 S WILLOW ST
Mailing Address - Street 2:568
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4531
Mailing Address - Country:US
Mailing Address - Phone:303-755-2900
Mailing Address - Fax:303-755-0404
Practice Address - Street 1:13547 W EXPOSITION DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-3041
Practice Address - Country:US
Practice Address - Phone:720-244-4498
Practice Address - Fax:720-963-0730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO214231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO214OtherSTATE LICENCSE
CO01092084OtherASHA CERTIFICATION