Healthcare Provider Details

I. General information

NPI: 1699616581
Provider Name (Legal Business Name): JENNIFER SAMPERISI LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2513 ELMIRA ST
AURORA CO
80010-1164
US

IV. Provider business mailing address

17829 GALLUP ST
BROOMFIELD CO
80023-5232
US

V. Phone/Fax

Practice location:
  • Phone: 720-593-1198
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPSLP.0001539
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: