Provider Demographics
NPI:1831450055
Name:NEALIS, JENNIFER MARIE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:NEALIS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1826 DEEP WOODS LN
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2370
Mailing Address - Country:US
Mailing Address - Phone:727-560-8758
Mailing Address - Fax:
Practice Address - Street 1:1826 DEEP WOODS LN
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2370
Practice Address - Country:US
Practice Address - Phone:727-560-8758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12476235Z00000X
FLSZ5770235Z00000X
COSLP.0004452235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist