Provider Demographics
NPI:1558877167
Name:MIGHTY MOUTH LLC
Entity Type:Organization
Organization Name:MIGHTY MOUTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:720-933-7447
Mailing Address - Street 1:6086 S ALTON WAY
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5223
Mailing Address - Country:US
Mailing Address - Phone:720-933-7447
Mailing Address - Fax:
Practice Address - Street 1:6086 S ALTON WAY
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-5223
Practice Address - Country:US
Practice Address - Phone:720-933-7447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO01096989235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty