Provider Demographics
NPI:1629513130
Name:KRUCKEBERG, JESSICA (LMFT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KRUCKEBERG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12835 E ARAPAHOE ROAD
Mailing Address - Street 2:TOWER 2, SUITE 440
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3940
Mailing Address - Country:US
Mailing Address - Phone:720-288-0645
Mailing Address - Fax:
Practice Address - Street 1:2101 S BLACKHAWK ST
Practice Address - Street 2:SUITE 240
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1492
Practice Address - Country:US
Practice Address - Phone:612-360-9935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001336106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist