Provider Demographics
NPI:1275208340
Name:BLACH, JENNA LOUISE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:LOUISE
Last Name:BLACH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W POWELL ST
Mailing Address - Street 2:
Mailing Address - City:HAXTUN
Mailing Address - State:CO
Mailing Address - Zip Code:80731-2654
Mailing Address - Country:US
Mailing Address - Phone:970-521-2771
Mailing Address - Fax:970-774-6157
Practice Address - Street 1:301 W POWELL
Practice Address - Street 2:
Practice Address - City:HAXTUN
Practice Address - State:CO
Practice Address - Zip Code:80731-0098
Practice Address - Country:US
Practice Address - Phone:970-521-2771
Practice Address - Fax:970-774-6157
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14397500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist