MEDICARE: JENNIFER SAMPERISI LOPEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	PSLP.0001539	CO

General Provider Information

NPI Number	:	1699616581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SAMPERISI LOPEZ

Provider Business Mailing Address
First Line	:	17829 GALLUP ST
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80023-5232
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2513 ELMIRA ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80010-1164
Country	:	US
Telephone Number	:	720-593-1198
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2026
Last Update Date	:	04/03/2026

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Directions to “ JENNIFER SAMPERISI LOPEZ ” Practice Location

Language	Start Address	Practice Location

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