Provider Demographics
NPI:1629378195
Name:JETTON, ANNA LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:LYNN
Last Name:JETTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W SOUTH AVE UNIT 273
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80866-7012
Mailing Address - Country:US
Mailing Address - Phone:719-286-9004
Mailing Address - Fax:
Practice Address - Street 1:1510 CRESTVIEW WAY
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-3337
Practice Address - Country:US
Practice Address - Phone:719-286-9004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO012533101YM0800X
CO3623103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health