Provider Demographics
NPI:1508012865
Name:GAHN-STAHLEY, JODIE LYNN (PA)
Entity Type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:LYNN
Last Name:GAHN-STAHLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:LYNN
Other - Last Name:SCHOENHOLTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2356 MEADOWS BLVD STE 140B
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-8410
Mailing Address - Country:US
Mailing Address - Phone:303-218-7774
Mailing Address - Fax:720-608-5781
Practice Address - Street 1:2356 MEADOWS BLVD STE 140B
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8410
Practice Address - Country:US
Practice Address - Phone:303-218-7774
Practice Address - Fax:720-608-5781
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine