Provider Demographics
NPI:1104473461
Name:ASPEN SPEECH THERAPY AND REHABILITATION LLC
Entity type:Organization
Organization Name:ASPEN SPEECH THERAPY AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC/SLP
Authorized Official - Phone:970-682-3743
Mailing Address - Street 1:1136 E STUART ST STE 3120
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1196
Mailing Address - Country:US
Mailing Address - Phone:970-682-3743
Mailing Address - Fax:
Practice Address - Street 1:101 KANANI RD
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-6805
Practice Address - Country:US
Practice Address - Phone:970-682-3743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPEN SPEECH THERAPY AND REHABILITATION LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty