Provider Demographics
NPI:1518003128
Name:DERK, JANE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:E
Last Name:DERK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 W 16TH STREET
Mailing Address - Street 2:BLDG 5 STE YY
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634
Mailing Address - Country:US
Mailing Address - Phone:970-351-6406
Mailing Address - Fax:970-336-0937
Practice Address - Street 1:3400 W 16TH STREET
Practice Address - Street 2:BLDG 5 STE YY
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634
Practice Address - Country:US
Practice Address - Phone:970-351-6406
Practice Address - Fax:970-336-0937
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1108103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical