Provider Demographics
NPI:1639346570
Name:FETROW, JAELEE ANN (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JAELEE
Middle Name:ANN
Last Name:FETROW
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 COLORADO AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2008
Mailing Address - Country:US
Mailing Address - Phone:719-334-9324
Mailing Address - Fax:
Practice Address - Street 1:509 COLORADO AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2008
Practice Address - Country:US
Practice Address - Phone:719-334-9324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW9928061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPENDINGMedicaid