Provider Demographics
NPI:1033595889
Name:NEELEY, JANE (SW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:NEELEY
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 CREE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-3165
Mailing Address - Country:US
Mailing Address - Phone:719-323-3537
Mailing Address - Fax:
Practice Address - Street 1:10 FARRAGUT AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5626
Practice Address - Country:US
Practice Address - Phone:719-327-2042
Practice Address - Fax:719-634-0482
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CO253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health