Provider Demographics
NPI:1700436243
Name:SU, JOCELYN JACEEN
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:JACEEN
Last Name:SU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 LAMBERT CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3117
Mailing Address - Country:US
Mailing Address - Phone:312-447-1207
Mailing Address - Fax:
Practice Address - Street 1:1312 LAMBERT CIR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3117
Practice Address - Country:US
Practice Address - Phone:312-447-1207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist