Provider Demographics
NPI:1710616743
Name:EARLY INTERVENTION PROFESSIONALS, LLC
Entity Type:Organization
Organization Name:EARLY INTERVENTION PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, OTR
Authorized Official - Phone:970-520-3625
Mailing Address - Street 1:22811 COUNTY ROAD 36
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-9207
Mailing Address - Country:US
Mailing Address - Phone:970-520-3625
Mailing Address - Fax:
Practice Address - Street 1:22811 COUNTY ROAD 36
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-9207
Practice Address - Country:US
Practice Address - Phone:970-520-3625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1932494184Medicaid
CO1356452536Medicaid