Provider Demographics
NPI:1407094972
Name:DYNAMIC SPEECH AND SWALLOWING, LLC
Entity Type:Organization
Organization Name:DYNAMIC SPEECH AND SWALLOWING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA/CCC-SLP
Authorized Official - Phone:303-694-8872
Mailing Address - Street 1:10496 E PINEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5472
Mailing Address - Country:US
Mailing Address - Phone:303-694-8872
Mailing Address - Fax:720-489-3874
Practice Address - Street 1:10496 E PINEWOOD AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80111-5472
Practice Address - Country:US
Practice Address - Phone:303-694-8872
Practice Address - Fax:720-489-3874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07809072Medicaid