Provider Demographics
NPI:1720372535
Name:SPEECH LANGUAGE PAL, LLC
Entity Type:Organization
Organization Name:SPEECH LANGUAGE PAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:M
Authorized Official - Last Name:VANLEEUWEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-548-4795
Mailing Address - Street 1:PO BOX 252,
Mailing Address - Street 2:110 EAGLE CANYON CIRCLE
Mailing Address - City:LYONS
Mailing Address - State:CO
Mailing Address - Zip Code:80540-0252
Mailing Address - Country:US
Mailing Address - Phone:303-548-4795
Mailing Address - Fax:
Practice Address - Street 1:110 EAGLE CANYON CIR
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:CO
Practice Address - Zip Code:80540-5011
Practice Address - Country:US
Practice Address - Phone:303-548-4795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO01110546235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21783543Medicaid