Provider Demographics
NPI:1760445738
Name:SUTLIFF, JANE A (PHD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:A
Last Name:SUTLIFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 MCCASLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2941
Mailing Address - Country:US
Mailing Address - Phone:720-313-3514
Mailing Address - Fax:303-926-5201
Practice Address - Street 1:357 MCCASLIN BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2941
Practice Address - Country:US
Practice Address - Phone:720-313-3514
Practice Address - Fax:303-926-5201
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2198103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07021983Medicaid
CO07021983Medicaid