Provider Demographics
NPI:1346888765
Name:VANSANT, MARY JENNINGS (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY JENNINGS
Middle Name:
Last Name:VANSANT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-1103
Mailing Address - Fax:970-469-4156
Practice Address - Street 1:175 INVERNESS DR W STE 300
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5069
Practice Address - Country:US
Practice Address - Phone:303-694-3333
Practice Address - Fax:303-221-4766
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO0003804235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist