Provider Demographics
NPI:1700499282
Name:NEURO-BASED SPEECH SOLUTIONS, LLC.
Entity Type:Organization
Organization Name:NEURO-BASED SPEECH SOLUTIONS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:831-643-5973
Mailing Address - Street 1:121 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3768
Mailing Address - Country:US
Mailing Address - Phone:970-615-7065
Mailing Address - Fax:970-514-7457
Practice Address - Street 1:121 N PARK AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3768
Practice Address - Country:US
Practice Address - Phone:970-615-7065
Practice Address - Fax:970-514-7457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty