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General NPI Number Information
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NPI Number | 1104767300
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Entity Type | Individual
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Provider Name | JAMIE RISDAL CCC-SLP
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Gender |
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Dates
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Enumeration Date | 04/02/2026
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Last Update Date | 04/02/2026
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Provider Practice Location Address
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Address Line | 16401 E CENTRETECH PKWY STE 2
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City | AURORA
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State | CO
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Zip | 80011-9066
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Country | US
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Telephone | 720-706-3396
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Fax |
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Provider Business Mailing Address
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Address Line | 8633 DATAPOINT DR APT 268
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3255
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Country | US
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Telephone | 832-331-1196
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 0006810
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License Number State | CO
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