Provider Demographics
NPI:1902935018
Name:IVINSON, JENNIFER FAITH (MA CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:FAITH
Last Name:IVINSON
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 E 19TH AVE # B030
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1007
Mailing Address - Country:US
Mailing Address - Phone:303-864-5951
Mailing Address - Fax:303-730-7544
Practice Address - Street 1:1056 E 19TH AVE # B030
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1007
Practice Address - Country:US
Practice Address - Phone:303-864-5951
Practice Address - Fax:303-730-7544
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO338231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO69920346Medicaid