MEDICARE: JESSIE HARDY CCC-SLP

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
1	235Z00000X	Speech-Language Pathologist	SLP.0002756	CO

General Provider Information

NPI Number	:	1376065664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIE HARDY CCC-SLP

Provider Business Mailing Address
First Line	:	1123 EUDORA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-4202
Country	:	US
Telephone Number	:	720-403-1947
Fax Number	:

Provider Business Practice Location Address
First Line	:	1123 EUDORA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-4202
Country	:	US
Telephone Number	:	703-409-9204
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2017
Last Update Date	:	10/22/2021

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Directions to “ JESSIE HARDY CCC-SLP” Practice Location

Language	Start Address	Practice Location

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