Provider Demographics
NPI:1952091472
Name:YOUR COGNITIVE COACH
Entity Type:Organization
Organization Name:YOUR COGNITIVE COACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LEAD SLP
Authorized Official - Prefix:
Authorized Official - First Name:MELEA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS/CCC-SLP
Authorized Official - Phone:720-988-7704
Mailing Address - Street 1:10020 TRAINSTATION CIR APT 157
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5360
Mailing Address - Country:US
Mailing Address - Phone:720-988-7704
Mailing Address - Fax:
Practice Address - Street 1:10020 TRAINSTATION CIR APT 157
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5360
Practice Address - Country:US
Practice Address - Phone:720-988-7704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist