Provider Demographics
NPI:1225023245
Name:WEBER, JENNIFER ELLEN (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ELLEN
Last Name:WEBER
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ELLEN
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31 POSTE VIEJO LN
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-9572
Mailing Address - Country:US
Mailing Address - Phone:970-330-4566
Mailing Address - Fax:
Practice Address - Street 1:UNC SPEECH AND AUDIOLOGY CLINIC
Practice Address - Street 2:GUNTER HALL ROOM 0330
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80639-0001
Practice Address - Country:US
Practice Address - Phone:970-351-2012
Practice Address - Fax:970-351-1601
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO113231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07481823Medicaid
CO07481823Medicaid