Provider Demographics
NPI:1326767880
Name:DEFENDERFER, JESSICA RENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:RENE
Last Name:DEFENDERFER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 HARLAN ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-5114
Mailing Address - Country:US
Mailing Address - Phone:865-254-4228
Mailing Address - Fax:
Practice Address - Street 1:7850 VANCE DR STE 225
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-2133
Practice Address - Country:US
Practice Address - Phone:303-431-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA120476231H00000X
CO1234237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist