Provider Demographics
NPI:1851855860
Name:BECKNER PEDIATRIC SPEECH THERAPY
Entity Type:Organization
Organization Name:BECKNER PEDIATRIC SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:BECKNER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:970-371-4888
Mailing Address - Street 1:180 50TH AVENUE PL
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4717
Mailing Address - Country:US
Mailing Address - Phone:970-371-4888
Mailing Address - Fax:
Practice Address - Street 1:180 50TH AVENUE PL
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4717
Practice Address - Country:US
Practice Address - Phone:970-371-4888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty