Provider Demographics
NPI:1568826550
Name:SCHORSCH SPEECH & LANGUAGE
Entity Type:Organization
Organization Name:SCHORSCH SPEECH & LANGUAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHORSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC
Authorized Official - Phone:970-672-7540
Mailing Address - Street 1:204 MAPLE ST UNIT 406
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2080
Mailing Address - Country:US
Mailing Address - Phone:970-672-7540
Mailing Address - Fax:970-692-2273
Practice Address - Street 1:204 MAPLE ST UNIT 406
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2080
Practice Address - Country:US
Practice Address - Phone:970-672-7540
Practice Address - Fax:970-692-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.00000018261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO53453239Medicaid