Provider Demographics
NPI:1013565373
Name:LASKOWITZ, JESSICA REID
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:REID
Last Name:LASKOWITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16259 W 10TH AVE APT H2
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3703
Mailing Address - Country:US
Mailing Address - Phone:303-885-5065
Mailing Address - Fax:
Practice Address - Street 1:10090 W 26TH AVE UNIT 100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-1400
Practice Address - Country:US
Practice Address - Phone:303-885-5065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2024-04-04
Deactivation Date:2021-09-23
Deactivation Code:
Reactivation Date:2024-04-03
Provider Licenses
StateLicense IDTaxonomies
CO101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor