Provider Demographics
NPI:1013405893
Name:COOLEY, JESSICA FERN (MS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:FERN
Last Name:COOLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:GERRARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 BROADWAY ST # 211
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4108
Mailing Address - Country:US
Mailing Address - Phone:720-771-6109
Mailing Address - Fax:
Practice Address - Street 1:2401 BROADWAY ST # 211
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4108
Practice Address - Country:US
Practice Address - Phone:720-771-6109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0107681102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst