Provider Demographics
NPI:1700658218
Name:EL PASO 12, CHEYENNE MOUNTAIN
Entity Type:Organization
Organization Name:EL PASO 12, CHEYENNE MOUNTAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:719-475-6140
Mailing Address - Street 1:1775 LACLEDE ST
Mailing Address - Street 2:1
Mailing Address - City:COLORADO SPRINGS CO
Mailing Address - State:CO
Mailing Address - Zip Code:80905
Mailing Address - Country:US
Mailing Address - Phone:719-475-6100
Mailing Address - Fax:
Practice Address - Street 1:1775 LACLEDE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS CO
Practice Address - State:CO
Practice Address - Zip Code:80905-8092
Practice Address - Country:US
Practice Address - Phone:719-475-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech