Provider Demographics
NPI:1700865821
Name:SPEECH & LANGUAGE STIMULATION CENTER
Entity Type:Organization
Organization Name:SPEECH & LANGUAGE STIMULATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-495-1150
Mailing Address - Street 1:760 WHALERS WAY
Mailing Address - Street 2:BLDG. C SUITE #100
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2023
Mailing Address - Country:US
Mailing Address - Phone:970-495-1150
Mailing Address - Fax:970-495-0133
Practice Address - Street 1:760 WHALERS WAY
Practice Address - Street 2:BLDG. C SUITE #100
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2023
Practice Address - Country:US
Practice Address - Phone:970-495-1150
Practice Address - Fax:970-495-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty