Provider Demographics
NPI:1477097657
Name:FRONT RANGE SPEECH AND BEHAVIOR
Entity Type:Organization
Organization Name:FRONT RANGE SPEECH AND BEHAVIOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP, MED
Authorized Official - Phone:714-478-1482
Mailing Address - Street 1:1303 PARK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SEVERANCE
Mailing Address - State:CO
Mailing Address - Zip Code:80615-8609
Mailing Address - Country:US
Mailing Address - Phone:714-478-1482
Mailing Address - Fax:
Practice Address - Street 1:7251 W 20TH ST
Practice Address - Street 2:UNIT P2
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4625
Practice Address - Country:US
Practice Address - Phone:970-778-4637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP0000936235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO28650077Medicaid