Provider Demographics
NPI:1548472624
Name:MANSANARES, JENNIFER ANN (M S CCC-A)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:MANSANARES
Suffix:
Gender:F
Credentials:M S CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W HAMPDEN PL
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2470
Mailing Address - Country:US
Mailing Address - Phone:303-788-7880
Mailing Address - Fax:303-788-7883
Practice Address - Street 1:401 W HAMPDEN PL
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2470
Practice Address - Country:US
Practice Address - Phone:303-788-7880
Practice Address - Fax:303-788-7883
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO359231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist