Provider Demographics
NPI:1174361109
Name:JESSEN, STACEY HANDLER (MA CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:HANDLER
Last Name:JESSEN
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9067 W 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3870
Mailing Address - Country:US
Mailing Address - Phone:303-907-9364
Mailing Address - Fax:
Practice Address - Street 1:5291 E 60TH AVE
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-3203
Practice Address - Country:US
Practice Address - Phone:303-853-3264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24462328235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist