Provider Demographics
NPI:1326340373
Name:PAUL, JENNIFER JOY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JOY
Last Name:PAUL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:JOY
Other - Last Name:OMDOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:13123 E 16TH AVE
Mailing Address - Street 2:THE GARY PAVILION AT THE CHILDREN'S HOSPITAL, B390
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7106
Mailing Address - Country:US
Mailing Address - Phone:303-864-5169
Mailing Address - Fax:303-864-5175
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:THE GARY PAVILION AT THE CHILDREN'S HOSPITAL, B390
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:303-864-5169
Practice Address - Fax:303-864-5175
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3135103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical