Individual
JEREMY IAN LEVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
401 W NORTHERN AVE, PUEBLO, CO 81004-3111
(562) 536-1692
Mailing address
1820 EL DORADO AVE, LA HABRA, CA 90631-4408
(562) 697-0224
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
235Z00000X
Speech-Language Pathologist
Primary
SLP.0005212
CO
Other
Enumeration date
03/22/2019
Last updated
03/18/2025
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