Provider Demographics
NPI:1790476703
Name:REDAR, JACLYN (CP)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:REDAR
Suffix:
Gender:F
Credentials:CP
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Other - Last Name:
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Mailing Address - Street 1:4110 BRIARGATE PARKWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7837
Mailing Address - Country:US
Mailing Address - Phone:719-867-7335
Mailing Address - Fax:719-867-7311
Practice Address - Street 1:4110 BRIARGATE PARKWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7837
Practice Address - Country:US
Practice Address - Phone:719-867-7335
Practice Address - Fax:719-867-7311
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist