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General NPI Number Information
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NPI Number | 1700448966
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Entity Type | Individual
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Provider Name | JESSICA BLAETTLER AUD
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Gender | Female
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Dates
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Enumeration Date | 07/08/2019
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | 4776 EAGLERIDGE CIR
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City | PUEBLO
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State | CO
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Zip | 81008-2189
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Country | US
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Telephone | 719-659-1846
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Fax |
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Provider Business Mailing Address
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Address Line | 3141 CENTENNIAL BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-4094
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Country | US
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Telephone | 719-227-4344
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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