Provider Demographics
NPI:1881089811
Name:GATES, JESSICA M (MS SLP-CCC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:GATES
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 1:16315 BLUEBELL PL
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9248
Mailing Address - Country:US
Mailing Address - Phone:303-868-7888
Mailing Address - Fax:
Practice Address - Street 1:10841 CROSSROADS DR STE 201
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9091
Practice Address - Country:US
Practice Address - Phone:720-515-8254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000981235Z00000X
CO117136235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist