Provider Demographics
NPI:1427625151
Name:HODGE, JENNA MARSHALL (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MARSHALL
Last Name:HODGE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 ROYAL VISTA CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80528-9321
Mailing Address - Country:US
Mailing Address - Phone:256-337-4943
Mailing Address - Fax:
Practice Address - Street 1:4650 ROYAL VISTA CIR STE 100
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80528-9321
Practice Address - Country:US
Practice Address - Phone:970-305-5070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0005086235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist