Provider Demographics
NPI:1568907129
Name:MY SPEECH THERAPIST LLC
Entity Type:Organization
Organization Name:MY SPEECH THERAPIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CRESWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:303-564-6495
Mailing Address - Street 1:2533 W 108TH PL
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3148
Mailing Address - Country:US
Mailing Address - Phone:303-564-6495
Mailing Address - Fax:303-469-7850
Practice Address - Street 1:2533 W 108TH PL
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-3148
Practice Address - Country:US
Practice Address - Phone:303-564-6495
Practice Address - Fax:303-469-7850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1352235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty