Provider Demographics
NPI:1699891101
Name:PATHWAYS THERAPY CENTER, LLC
Entity type:Organization
Organization Name:PATHWAYS THERAPY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:MS-CCC-SLP
Authorized Official - Phone:303-333-4062
Mailing Address - Street 1:215 ST. PAUL STREET
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206
Mailing Address - Country:US
Mailing Address - Phone:303-333-4062
Mailing Address - Fax:303-333-4097
Practice Address - Street 1:215 ST. PAUL STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206
Practice Address - Country:US
Practice Address - Phone:303-333-4062
Practice Address - Fax:303-333-4097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10770235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90600542OtherMEDICAID WAIVER
CO41609395Medicaid