Provider Demographics
NPI:1710966973
Name:TENNYSON, JAIME (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:TENNYSON
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 1:13325 SHILOH RD
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-5103
Mailing Address - Country:US
Mailing Address - Phone:303-910-1554
Mailing Address - Fax:303-484-2524
Practice Address - Street 1:13325 SHILOH RD
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-5103
Practice Address - Country:US
Practice Address - Phone:303-910-1554
Practice Address - Fax:303-484-2524
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-15
Last Update Date:2016-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12071582235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO32781393Medicaid