Provider Demographics
NPI:1346888765
Name:VANSANT, MARY JENNINGS (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY JENNINGS
Middle Name:
Last Name:VANSANT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 GALAPAGO ST APT 209
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-3594
Mailing Address - Country:US
Mailing Address - Phone:301-675-2868
Mailing Address - Fax:
Practice Address - Street 1:900 POTOMAC ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6716
Practice Address - Country:US
Practice Address - Phone:303-788-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003804235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist