Provider Demographics
NPI:1578920997
Name:BEYOND CLASSROOM WALLS
Entity Type:Organization
Organization Name:BEYOND CLASSROOM WALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC-SLP
Authorized Official - Phone:303-330-3309
Mailing Address - Street 1:2600 S PARKER RD STE 336
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1613
Mailing Address - Country:US
Mailing Address - Phone:303-330-3309
Mailing Address - Fax:303-862-9770
Practice Address - Street 1:2600 S PARKER RD STE 336
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1613
Practice Address - Country:US
Practice Address - Phone:303-330-3309
Practice Address - Fax:303-862-9770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-16
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1226251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health