Provider Demographics
NPI:1255690202
Name:ANDERSON, JENNIFER M (BA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19226 E CAROLINA PL
Mailing Address - Street 2:UNIT 103
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-6352
Mailing Address - Country:US
Mailing Address - Phone:720-891-6872
Mailing Address - Fax:
Practice Address - Street 1:6509 S SANTE FE DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120
Practice Address - Country:US
Practice Address - Phone:303-797-9343
Practice Address - Fax:303-797-9345
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health