Provider Demographics
NPI:1225294895
Name:MADDOX, JENNIFER DAWN (LSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DAWN
Last Name:MADDOX
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 DEXTER ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-3152
Mailing Address - Country:US
Mailing Address - Phone:303-748-5597
Mailing Address - Fax:303-484-3575
Practice Address - Street 1:495 UINTA WAY
Practice Address - Street 2:SUITE 120
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7110
Practice Address - Country:US
Practice Address - Phone:303-344-4100
Practice Address - Fax:303-484-3575
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10352101YM0800X
CO427104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health