Provider Demographics
NPI:1891080438
Name:JANSEN, EDIE (MS-SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:EDIE
Middle Name:
Last Name:JANSEN
Suffix:
Gender:F
Credentials:MS-SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 LODGEPOLE CIR
Mailing Address - Street 2:
Mailing Address - City:PARACHUTE
Mailing Address - State:CO
Mailing Address - Zip Code:81635-9572
Mailing Address - Country:US
Mailing Address - Phone:970-285-0384
Mailing Address - Fax:
Practice Address - Street 1:515 LODGEPOLE CIR
Practice Address - Street 2:
Practice Address - City:PARACHUTE
Practice Address - State:CO
Practice Address - Zip Code:81635-9572
Practice Address - Country:US
Practice Address - Phone:970-285-0384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist