Provider Demographics
NPI:1376096446
Name:COLUMBINE SPEECH THERAPY
Entity Type:Organization
Organization Name:COLUMBINE SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-389-6598
Mailing Address - Street 1:126 SNOWBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:CO
Mailing Address - Zip Code:80435-8353
Mailing Address - Country:US
Mailing Address - Phone:970-389-6598
Mailing Address - Fax:970-262-3574
Practice Address - Street 1:126 SNOWBERRY WAY
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:CO
Practice Address - Zip Code:80435-8353
Practice Address - Country:US
Practice Address - Phone:970-389-6598
Practice Address - Fax:970-262-3574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO108355235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty