Provider Demographics
NPI:1578690558
Name:PANTONE, JEANNE L (LCP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:L
Last Name:PANTONE
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9139 SOUTH RIDGELINE BOULEVARD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2333
Mailing Address - Country:US
Mailing Address - Phone:303-338-4545
Mailing Address - Fax:
Practice Address - Street 1:9139 SOUTH RIDGELINE BOULEVARD
Practice Address - Street 2:SUITE 210
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2333
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO844103TC0700X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
009112OtherKAISER-COMMERCIAL NUMBER
CO07107691Medicaid
COCOA105648Medicare PIN
COCK10902Medicare PIN
CO07107691Medicaid