Provider Demographics
NPI:1992195390
Name:MENDELL, JAMIE RAE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:RAE
Last Name:MENDELL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:RAE
Other - Last Name:REICHERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3665 HEATHER GLEN DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-3113
Mailing Address - Country:US
Mailing Address - Phone:719-237-2038
Mailing Address - Fax:
Practice Address - Street 1:3665 HEATHER GLEN DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-3113
Practice Address - Country:US
Practice Address - Phone:719-237-2038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14094446235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist