Provider Demographics
NPI:1114051414
Name:KOMMERSTAD, ERIN JENNIFER
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:JENNIFER
Last Name:KOMMERSTAD
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 1:200 RAMPART WAY
Mailing Address - Street 2:#230
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6852
Mailing Address - Country:US
Mailing Address - Phone:602-561-9784
Mailing Address - Fax:
Practice Address - Street 1:9485 W COLFAX AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-3918
Practice Address - Country:US
Practice Address - Phone:602-561-9784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program