Provider Demographics
NPI:1295367357
Name:COLGAN, JENNIFER ZAMORA
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ZAMORA
Last Name:COLGAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9120 JUDICIAL DR UNIT 7211
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-6703
Mailing Address - Country:US
Mailing Address - Phone:760-216-3393
Mailing Address - Fax:
Practice Address - Street 1:911 HACIENDA DR STE B
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6503
Practice Address - Country:US
Practice Address - Phone:760-216-6942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59162355S0801X
CA17371235Z00000X
CA36104235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty