Provider Demographics
NPI:1023253929
Name:ELIZABETH STRAKA SPEECH ASSOCIATES
Entity type:Organization
Organization Name:ELIZABETH STRAKA SPEECH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-633-9114
Mailing Address - Street 1:516 W BIJOU ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-1311
Mailing Address - Country:US
Mailing Address - Phone:719-633-9114
Mailing Address - Fax:719-329-0495
Practice Address - Street 1:516 W BIJOU ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1311
Practice Address - Country:US
Practice Address - Phone:719-633-9114
Practice Address - Fax:719-329-0495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38232553Medicaid