Healthcare Provider Details

I. General information

NPI: 1942118575
Provider Name (Legal Business Name): JAMMIE ANN BENTON-SPEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 FOREST PARK CIR STE 130T
LAFAYETTE CO
80026-3378
US

IV. Provider business mailing address

763 GRAHAM CIR
ERIE CO
80516-3614
US

V. Phone/Fax

Practice location:
  • Phone: 720-937-9964
  • Fax:
Mailing address:
  • Phone: 720-937-9964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0024131
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: