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NPI Code Detail

MEDICARE: JESSICA LYN NICOLE STEPHENS M.S., CCC-SLP

MEDICARE: JESSICA LYN NICOLE STEPHENS M.S., CCC-SLP
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
12355S0801XSpeech-Language AssistantSLPA7743AZ
2235Z00000XSpeech-Language PathologistCO

General Provider Information

NPI Number : 1912269267
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LYN NICOLE STEPHENS M.S., CCC-SLP
Provider Business Mailing Address
First Line : PO BOX 7094
Second Line :
City : WOODLAND PARK
State : CO
Zip : 80863-0094
Country : US
Telephone Number : 928-243-3246
Fax Number :
Provider Business Practice Location Address
First Line : 830 TENDERFOOT HILL RD STE 100
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80906-7372
Country : US
Telephone Number : 719-623-4500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2012
Last Update Date : 04/02/2019

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