Provider Demographics
NPI:1467907428
Name:JENNINGS, JILLIE (MS SLP CF)
Entity Type:Individual
Prefix:
First Name:JILLIE
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MS SLP CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11177 WEST 8TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-5520
Mailing Address - Country:US
Mailing Address - Phone:303-462-6509
Mailing Address - Fax:
Practice Address - Street 1:11177 WEST 8TH AVENUE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-5520
Practice Address - Country:US
Practice Address - Phone:303-462-6509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002983235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist