Provider Demographics
NPI:1609380807
Name:NELSEN, JESSICA SUSAN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SUSAN
Last Name:NELSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1830
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-1830
Mailing Address - Country:US
Mailing Address - Phone:303-931-8831
Mailing Address - Fax:
Practice Address - Street 1:101 WEST MAIN STREET
Practice Address - Street 2:#107
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-8049
Practice Address - Country:US
Practice Address - Phone:303-931-8831
Practice Address - Fax:303-931-8831
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst