Provider Demographics
NPI:1679097513
Name:BARTHOLOMEW, JESSICA MARIE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:BARTHOLOMEW
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 1:136 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2511
Mailing Address - Country:US
Mailing Address - Phone:219-916-4302
Mailing Address - Fax:
Practice Address - Street 1:1901 56TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2950
Practice Address - Country:US
Practice Address - Phone:970-702-2998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2018-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist