Provider Demographics
NPI:1578878054
Name:NORTHERN COLORADO SPEECH & LANGUAGE THERAPY, INC
Entity Type:Organization
Organization Name:NORTHERN COLORADO SPEECH & LANGUAGE THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:720-771-3730
Mailing Address - Street 1:4604 CALABRIA PL
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-4102
Mailing Address - Country:US
Mailing Address - Phone:720-771-3730
Mailing Address - Fax:720-545-9903
Practice Address - Street 1:4604 CALABRIA PL
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-4102
Practice Address - Country:US
Practice Address - Phone:720-771-3730
Practice Address - Fax:720-545-9903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12103437235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty