Provider Demographics
NPI:1255005948
Name:JORDAN KERTZNER, SUE X (LPC)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:JORDAN KERTZNER
Suffix:X
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-8357
Mailing Address - Country:US
Mailing Address - Phone:303-579-9315
Mailing Address - Fax:
Practice Address - Street 1:1910 7TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5026
Practice Address - Country:US
Practice Address - Phone:303-579-9315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5137101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional