Provider Demographics
NPI:1619101938
Name:DURANGO SPEECH AND LANGUAGE CENTER
Entity Type:Organization
Organization Name:DURANGO SPEECH AND LANGUAGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MACCC-SLP
Authorized Official - Phone:970-769-1661
Mailing Address - Street 1:264 DAVIDSON CREEK RD STE B
Mailing Address - Street 2:SUITE B
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7916
Mailing Address - Country:US
Mailing Address - Phone:970-769-1661
Mailing Address - Fax:
Practice Address - Street 1:264 DAVIDSON CREEK RD
Practice Address - Street 2:SUITE B
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7916
Practice Address - Country:US
Practice Address - Phone:970-769-1661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty