Provider Demographics
NPI:1447591557
Name:COLORADO BILINGUAL SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:COLORADO BILINGUAL SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.A. CCC-SLP
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:HICKAM
Authorized Official - Last Name:FLENNIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-515-1289
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:IDAHO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80452-0118
Mailing Address - Country:US
Mailing Address - Phone:720-515-1289
Mailing Address - Fax:303-379-3922
Practice Address - Street 1:5130 W 80TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030-4450
Practice Address - Country:US
Practice Address - Phone:303-974-8704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12095692235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty