| NPI | 1760080386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY BALLARD Executive Director 719-314-8739 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2020-10-15 |
| Last Update Date | 2021-09-30 |