Provider Demographics
NPI:1063792521
Name:DYDEL, JENNIFER S (MA, CCC/SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:DYDEL
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5074 S GOLD BUG WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-4264
Mailing Address - Country:US
Mailing Address - Phone:303-525-3796
Mailing Address - Fax:720-242-8085
Practice Address - Street 1:5074 S GOLD BUG WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-4264
Practice Address - Country:US
Practice Address - Phone:303-525-3796
Practice Address - Fax:720-242-8085
Is Sole Proprietor?:No
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist