NPIMap

Organization Active NPI

Proactive Pediatrics, LLC

  • Speech-Language Pathologist
  • Denver, CO
National Provider Identifier
1346639507
Registry record updated Jan 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
PROACTIVE PEDIATRICS, LLC
Practice address
1143 Ivy St
Denver, CO 80220-4542
Phone
(720) 318-4615
NPI assigned
Jan 12, 2015
Last updated
Jan 12, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Emily Irene Poliseo, MA, CCC-SLPNPI 1073782876
Title
Owner, Speech Language Pathologist
Phone
(720) 318-4615

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X NU Primary

Addresses

Primary practice location

1143 Ivy St
Denver, CO 80220-4542

Mailing address

1143 Ivy St
Denver, CO 80220-4542
Phone (720) 318-4615

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421020800000",
    "number": "1346639507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1143 IVY ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802204542",
            "telephone_number": "720-318-4615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1143 IVY ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802204542",
            "telephone_number": "720-318-4615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-12",
        "last_updated": "2015-01-12",
        "status": "A",
        "authorized_official_last_name": "POLISEO",
        "authorized_official_first_name": "EMILY",
        "authorized_official_middle_name": "IRENE",
        "authorized_official_title_or_position": "OWNER, SPEECH LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "720-318-4615",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA, CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.