Provider Demographics
NPI:1730491978
Name:NORTHERN COLORADO SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:NORTHERN COLORADO SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:970-430-9997
Mailing Address - Street 1:1748 TOPAZ DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-5000
Mailing Address - Country:US
Mailing Address - Phone:970-800-3287
Mailing Address - Fax:970-549-2514
Practice Address - Street 1:1748 TOPAZ DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-5000
Practice Address - Country:US
Practice Address - Phone:970-702-2998
Practice Address - Fax:970-549-2514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-03
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QH0700X
CO1083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12745520OtherCAQH
CO36620777Medicaid
CO9000151501Medicaid