Provider Demographics
NPI:1154473353
Name:AHN, JAE W (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JAE
Middle Name:W
Last Name:AHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 S HAVANA ST STE 707
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4034
Mailing Address - Country:US
Mailing Address - Phone:303-517-5570
Mailing Address - Fax:303-309-3990
Practice Address - Street 1:1450 S HAVANA ST STE 707
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4034
Practice Address - Country:US
Practice Address - Phone:303-517-5570
Practice Address - Fax:303-309-3990
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO147500101YA0400X
CO2411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical