Provider Demographics
NPI:1629536941
Name:GLAHN, JESSICA MARIAH (LAC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIAH
Last Name:GLAHN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9465 W WESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-2239
Mailing Address - Country:US
Mailing Address - Phone:720-771-0486
Mailing Address - Fax:
Practice Address - Street 1:677 S COLORADO BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-8019
Practice Address - Country:US
Practice Address - Phone:720-744-0666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002357171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist