Provider Demographics
NPI:1386869196
Name:FLENNIKEN, JENNIFER HICKAM (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HICKAM
Last Name:FLENNIKEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 W DIXIE PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-1537
Mailing Address - Country:US
Mailing Address - Phone:303-974-8704
Mailing Address - Fax:
Practice Address - Street 1:1360 S WADSWORTH BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-5415
Practice Address - Country:US
Practice Address - Phone:303-974-8704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29577039Medicaid
COANTHEMOther649046
CO841465539OtherTAX ID
CO29577039Medicaid