Provider Demographics
NPI:1376876748
Name:HAAKSMA SPEECH PATHOLOGY, LLC
Entity Type:Organization
Organization Name:HAAKSMA SPEECH PATHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:033-755-3170
Mailing Address - Street 1:2821 S PARKER RD STE 615
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2711
Mailing Address - Country:US
Mailing Address - Phone:303-840-6374
Mailing Address - Fax:
Practice Address - Street 1:2821 S PARKER RD STE 615
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2711
Practice Address - Country:US
Practice Address - Phone:303-755-3170
Practice Address - Fax:033-755-3217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04J985251E00000X
CO01109430235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41750128Medicaid