Provider Demographics
NPI:1063107217
Name:THORMODSGAARD, JENNIFER JOYCE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOYCE
Last Name:THORMODSGAARD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JOYCE
Other - Last Name:HEWITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6297 DONAHUE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-7665
Mailing Address - Country:US
Mailing Address - Phone:402-319-1901
Mailing Address - Fax:
Practice Address - Street 1:6297 DONAHUE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-7665
Practice Address - Country:US
Practice Address - Phone:402-319-1901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO317962235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist