Skylar Fendrick, M.A., CCC-SLP

Key facts

NPI

1245079177

Entity type

Individual (NPI type 1)

Primary specialty

Speech-Language Pathologist 235Z00000X

License

SLP.0005917 (CO)

Practice address

10184 E I25 Frontage Rd
Firestone, CO 80504-5445

Phone

(720) 378-6670

NPI assigned

May 21, 2024

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Master of Arts

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 18, 2024.

{
    "created_epoch": "1716249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718668800000",
    "number": "1245079177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10184 E I25 FRONTAGE RD",
            "city": "FIRESTONE",
            "state": "CO",
            "postal_code": "805045445",
            "telephone_number": "720-378-6670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10184 E I25 FRONTAGE RD",
            "city": "FIRESTONE",
            "state": "CO",
            "postal_code": "805045445",
            "telephone_number": "720-378-6670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENDRICK",
        "first_name": "SKYLAR",
        "credential": "M.A., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-21",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CO",
            "license": "SLP.0005917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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