Provider Demographics
NPI:1174048847
Name:REYNOLDS, JANA RAE (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:RAE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21150
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-4150
Mailing Address - Country:US
Mailing Address - Phone:303-250-4291
Mailing Address - Fax:720-789-2210
Practice Address - Street 1:5954 S QUATAR CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-5015
Practice Address - Country:US
Practice Address - Phone:303-250-4291
Practice Address - Fax:720-789-2210
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMSSLP.0000005235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO251E00000XOther251E00000X - HOME HEALTH