| Organization Name: | ADVANCED DYSPHAGIA DIAGNOSTICS LLC |
| NPI Number: | 1194181206 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIMRY A GEMMELL (OWNER) |
| Mailing Address: | 19665 Hwy 550 South Montrose |
| State: | CO US |
| Postal Code: | 81403 |
| Phone Number: | 9092135967 |
| Fax Number: | 9702404916 |
| NPI Enumeration Date: | 01/05/2016 |
| NPI Last Update Date: | 01/05/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SLP.0000229 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |