Provider Demographics
NPI:1831853928
Name:KVK SPEECH THERAPY
Entity type:Organization
Organization Name:KVK SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KATELYN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SULLIVAN-VANKEUREN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:208-221-7375
Mailing Address - Street 1:4750 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-3530
Mailing Address - Country:US
Mailing Address - Phone:208-221-7375
Mailing Address - Fax:
Practice Address - Street 1:4750 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3530
Practice Address - Country:US
Practice Address - Phone:208-221-7375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
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
COSLP.0000513OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES