Provider Demographics
NPI:1457965584
Name:DRAGONFLY PEDIATRIC SPEECH THERAPY
Entity type:Organization
Organization Name:DRAGONFLY PEDIATRIC SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:720-515-8254
Mailing Address - Street 1:9000 E NICHOLS AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3406
Mailing Address - Country:US
Mailing Address - Phone:720-515-8254
Mailing Address - Fax:720-575-9914
Practice Address - Street 1:9000 E NICHOLS AVE STE 140
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3406
Practice Address - Country:US
Practice Address - Phone:720-515-8254
Practice Address - Fax:720-575-9914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-05
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1881089811Medicaid