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NPI Code Detail

MEDICARE: JESSICA ANNELIESE MACE MS

MEDICARE: JESSICA ANNELIESE MACE MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist0004416CO
2235Z00000XSpeech-Language Pathologist13452NC
3235Z00000XSpeech-Language Pathologist2202011328VA

General Provider Information

NPI Number : 1043702657
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA ANNELIESE MACE MS
Provider Business Mailing Address
First Line : 4629 SHEMIN CT APT C
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80902-1229
Country : US
Telephone Number : 661-886-1023
Fax Number :
Provider Business Practice Location Address
First Line : 901 N SANTA FE AVE
Second Line :
City : FOUNTAIN
State : CO
Zip : 80817-1738
Country : US
Telephone Number : 719-822-0550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2018
Last Update Date : 10/14/2024

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Directions to “ JESSICA ANNELIESE MACE MS” Practice Location

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