Provider Demographics
NPI:1407921133
Name:FREEDOM OF SPEECH, LLC
Entity Type:Organization
Organization Name:FREEDOM OF SPEECH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR, SPEECH-LANG PATHOLOGIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCLANE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:407-252-8905
Mailing Address - Street 1:1603 TURIN DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-2717
Mailing Address - Country:US
Mailing Address - Phone:407-252-8905
Mailing Address - Fax:303-501-1720
Practice Address - Street 1:1603 TURIN DR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-2717
Practice Address - Country:US
Practice Address - Phone:407-252-8905
Practice Address - Fax:303-501-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000140235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0000140OtherSTATE LICENSE
FL12085988OtherASHA BOARD CERTIFICATION
FLSA8295OtherSTATE LICENSE
1407921133OtherGROUP NPI
CO93231067Medicaid