Provider Demographics
NPI:1356065791
Name:JUNIPER SPEECH & LANGUAGE THERAPY
Entity type:Organization
Organization Name:JUNIPER SPEECH & LANGUAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXA
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:HERBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-259-1925
Mailing Address - Street 1:PO BOX 983
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80151-0983
Mailing Address - Country:US
Mailing Address - Phone:720-640-0472
Mailing Address - Fax:
Practice Address - Street 1:3651 E 31ST AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-4907
Practice Address - Country:US
Practice Address - Phone:720-640-0472
Practice Address - Fax:720-792-4612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-29
Last Update Date:2024-09-13
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
CO90001751222Medicaid