Provider Demographics
NPI:1639491434
Name:PIKES PEAK STUTTERING CENTER
Entity Type:Organization
Organization Name:PIKES PEAK STUTTERING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LAUTENSCHLAGER
Authorized Official - Suffix:II
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:719-278-9009
Mailing Address - Street 1:1505 OWL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1529
Mailing Address - Country:US
Mailing Address - Phone:719-278-9009
Mailing Address - Fax:
Practice Address - Street 1:1505 OWL RIDGE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1529
Practice Address - Country:US
Practice Address - Phone:719-278-9009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12093735235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty