Provider Demographics
NPI:1104061100
Name:FRONT RANGE THERAPISTS
Entity type:Organization
Organization Name:FRONT RANGE THERAPISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:LACY
Authorized Official - Last Name:HOYER
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:970-381-3183
Mailing Address - Street 1:504 E 23RD STREET RD
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-9049
Mailing Address - Country:US
Mailing Address - Phone:970-381-3183
Mailing Address - Fax:
Practice Address - Street 1:504 E 23RD STREET RD
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-9049
Practice Address - Country:US
Practice Address - Phone:970-381-3183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPENDINGMedicaid