Provider Demographics
NPI:1083358139
Name:FLECHSIG, JEREMY ALLEN
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:ALLEN
Last Name:FLECHSIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JEREMY
Other - Middle Name:ALLEN
Other - Last Name:GAINES-FLECHSIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ADOPTED FEB 17, 1998
Mailing Address - Street 1:10067 IDALIA ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-9388
Mailing Address - Country:US
Mailing Address - Phone:720-671-9406
Mailing Address - Fax:
Practice Address - Street 1:10067 IDALIA ST
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-9388
Practice Address - Country:US
Practice Address - Phone:720-671-9406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00000000OtherVA