Doctor Name: | JENNIE P EWALT |
NPI Number: | 1427225291 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S., CCC-SLP |
License Number: | 12085674 |
Business Practice Address: | 3248 E 118th Way Thornton, CO - 802331518 |
Business Phone Number: | 3035035724 |
Business Fax Number: | |
Mailing Address: | 3248 E 118th Way, THORNTON |
State: | CO |
Postal Code: | 802331518 |
Phone Number: | 3035035724 |
Fax Number: | |
NPI Enumeration Date: | 05/12/2008 |
NPI Last Update Date: | 05/12/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 12085674 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |