Provider Demographics
NPI:1689299315
Name:BASLER, JENNIFER T (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:BASLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9362 GRAND CORDERA PKWY STE 170
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924
Mailing Address - Country:US
Mailing Address - Phone:719-627-3233
Mailing Address - Fax:
Practice Address - Street 1:9362 GRAND CORDERA PKWY STE 170
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924
Practice Address - Country:US
Practice Address - Phone:719-627-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2021-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.000010921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCSW.00001092OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES (DORA)