Provider Demographics
NPI:1902068521
Name:JOSE, BINU (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:BINU
Middle Name:
Last Name:JOSE
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2449 QUAIL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-6536
Mailing Address - Country:US
Mailing Address - Phone:720-242-9030
Mailing Address - Fax:
Practice Address - Street 1:2449 QUAIL CREEK DR
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-6536
Practice Address - Country:US
Practice Address - Phone:303-524-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12080162235Z00000X
IN22003820A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist