Provider Demographics
NPI:1477724185
Name:SPEECH, LANGUAGE & HEARING CLINIC
Entity Type:Organization
Organization Name:SPEECH, LANGUAGE & HEARING CLINIC
Other - Org Name:UNIVERSITY OF COLORADO AT BOULDER
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-492-5284
Mailing Address - Street 1:2501 KITTREDGE LOOP ROAD
Mailing Address - Street 2:SPEECH, LANGUAGE & HEARING CENTER 409 UCB
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80309-0409
Mailing Address - Country:US
Mailing Address - Phone:303-492-5375
Mailing Address - Fax:303-492-3274
Practice Address - Street 1:2501 KITTREDGE LOOP ROAD
Practice Address - Street 2:SPEECH, LANGUAGE & HEARING CENTER 409 UCB
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309-0409
Practice Address - Country:US
Practice Address - Phone:303-492-5375
Practice Address - Fax:303-492-3274
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF COLORADO AT BOULDER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Multi-Specialty
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty