Provider Demographics
NPI:1720614167
Name:GREY MATTER SPEECH THERAPY
Entity Type:Organization
Organization Name:GREY MATTER SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-286-7350
Mailing Address - Street 1:4816 KEY LARGO DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-4634
Mailing Address - Country:US
Mailing Address - Phone:970-286-7350
Mailing Address - Fax:
Practice Address - Street 1:4816 KEY LARGO DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-4634
Practice Address - Country:US
Practice Address - Phone:970-286-7350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
1811215148OtherINDIVIDUAL NPI (TYPE 1)