Provider Demographics
NPI:1073138848
Name:PERRY, JESSICA LORRAINE (LCSW, RN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LORRAINE
Last Name:PERRY
Suffix:
Gender:F
Credentials:LCSW, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18609 W 84TH PL
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-7199
Mailing Address - Country:US
Mailing Address - Phone:301-471-0836
Mailing Address - Fax:
Practice Address - Street 1:18609 W 84TH PL
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-7199
Practice Address - Country:US
Practice Address - Phone:301-471-0836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD174771041C0700X
CO1643548163WG0000X
CO099267011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice