Provider Demographics
NPI:1487829909
Name:TOMBERLIN, JODY LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:LYNN
Last Name:TOMBERLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:LYNN
Other - Last Name:BONAVENTURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4604 POLEPLANT DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5261
Mailing Address - Country:US
Mailing Address - Phone:719-502-9530
Mailing Address - Fax:
Practice Address - Street 1:4620 EDISON AVE
Practice Address - Street 2:UNIT J.
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-4125
Practice Address - Country:US
Practice Address - Phone:719-502-9530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLCSW #10241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical