Provider Demographics
NPI:1790561538
Name:BLUEBIRD SKY THERAPY
Entity Type:Organization
Organization Name:BLUEBIRD SKY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLKENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:812-483-0394
Mailing Address - Street 1:6767 S VINE ST # 1176
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-3171
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8415 BRIAR TRACE DRIVE
Practice Address - Street 2:
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108
Practice Address - Country:US
Practice Address - Phone:812-483-0394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech