Healthcare Provider Details

I. General information

NPI: 1346888765
Provider Name (Legal Business Name): MARY JENNINGS VANSANT MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 INVERNESS DR W STE 300
ENGLEWOOD CO
80112-5069
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 303-694-3333
  • Fax: 303-221-4766
Mailing address:
  • Phone: 970-624-1103
  • Fax: 970-469-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0003804
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: