Provider Demographics
NPI:1376688119
Name:BLOCKHUS, JENNA (MS)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:
Last Name:BLOCKHUS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4758 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-0862
Mailing Address - Country:US
Mailing Address - Phone:602-999-5704
Mailing Address - Fax:
Practice Address - Street 1:1123 MURIEL DR
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233-3151
Practice Address - Country:US
Practice Address - Phone:720-972-5115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL4130235Z00000X
CO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist