Healthcare Provider Details

I. General information

NPI: 1891328811
Provider Name (Legal Business Name): JAIME WEISBROT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 10/12/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 S COLORADO BLVD STE 20
DENVER CO
80246-8010
US

IV. Provider business mailing address

695 S COLORADO BLVD STE 20
DENVER CO
80246-8010
US

V. Phone/Fax

Practice location:
  • Phone: 303-360-0727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: