Provider Demographics
NPI:1922763390
Name:LEAP SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:LEAP SPEECH THERAPY LLC
Other - Org Name:LEAP SPEECH THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-301-0218
Mailing Address - Street 1:PO BOX 2064
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-2064
Mailing Address - Country:US
Mailing Address - Phone:719-301-0218
Mailing Address - Fax:719-931-5579
Practice Address - Street 1:110 1/2 N TEJON ST STE 204
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1434
Practice Address - Country:US
Practice Address - Phone:719-301-0218
Practice Address - Fax:719-931-5579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty