Provider Demographics
NPI:1518580810
Name:INDIGO SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:INDIGO SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ESTEFANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMERA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC - SLP
Authorized Official - Phone:786-536-0040
Mailing Address - Street 1:6750 E CHENANGO AVE APT 693
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3186
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6750 E CHENANGO AVE APT 693
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-3186
Practice Address - Country:US
Practice Address - Phone:786-536-0040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QA3000XAmbulatory Health Care FacilitiesClinic/CenterAugmentative Communication
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities