Provider Demographics
NPI:1225097959
Name:HUSEMAN, JENNIFER JOY HARDIN (ATC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JOY HARDIN
Last Name:HUSEMAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:JOY
Other - Last Name:HARDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:PO BOX 173362
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-3362
Mailing Address - Country:US
Mailing Address - Phone:417-770-4017
Mailing Address - Fax:303-556-8301
Practice Address - Street 1:1201 5TH ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-2005
Practice Address - Country:US
Practice Address - Phone:303-615-1328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00011642255A2300X
MO19991351532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1999135153OtherMISSOURI DIVISION OF PROFESSIONAL REGISTRATION
COAT.0001164OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES