Provider Demographics
NPI:1437782729
Name:SUMMIT SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:SUMMIT SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:617-448-5633
Mailing Address - Street 1:4632 ECHO CIR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-4568
Mailing Address - Country:US
Mailing Address - Phone:617-448-5633
Mailing Address - Fax:
Practice Address - Street 1:1931 65TH AVE STE C
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-7946
Practice Address - Country:US
Practice Address - Phone:970-702-2507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-15
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0001175OtherSTATE LICENSE
12067828OtherASHA CERTIFICATION