Provider Demographics
NPI:1326619560
Name:GOULDER, JACOB FELIX ROSENSCHEIN
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:FELIX ROSENSCHEIN
Last Name:GOULDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MEADE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-1351
Mailing Address - Country:US
Mailing Address - Phone:303-868-7380
Mailing Address - Fax:
Practice Address - Street 1:2205 W 29TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3803
Practice Address - Country:US
Practice Address - Phone:303-868-7380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical