Provider Demographics
NPI:1437880473
Name:LUGO, JESSICA CHRISTINE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CHRISTINE
Last Name:LUGO
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 1:6611 W 96TH AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-6485
Mailing Address - Country:US
Mailing Address - Phone:512-468-4435
Mailing Address - Fax:
Practice Address - Street 1:6611 W 96TH AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-6485
Practice Address - Country:US
Practice Address - Phone:512-468-4435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0000766235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist