Organization
ADVANCED DYSPHAGIA DIAGNOSTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY A GEMMELL MS, CCC-SLP (OWNER)
(909) 213-5967
Entity
Organization
Contact information
Practice address
611 E STAR CT, MONTROSE, CO 81401-6704
(909) 213-5967
(509) 356-4607
Mailing address
2233 E MAIN ST, BUSINESS OPTIONS MEDICAL BILLING, MONTROSE, CO 81401-3831
(970) 765-0818
(970) 497-8410
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP.0000229
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DW7861
RAILROAD WORKERS MEDICARE GROUP PTAN
CO
Enumeration date
01/05/2016
Last updated
10/09/2019
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