Provider Demographics
NPI:1801037759
Name:LONDON, JEAN CLARA (CMT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:CLARA
Last Name:LONDON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5418 HIGHWAY 93
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-8022
Mailing Address - Country:US
Mailing Address - Phone:303-720-2005
Mailing Address - Fax:
Practice Address - Street 1:5418 HIGHWAY 93
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-8022
Practice Address - Country:US
Practice Address - Phone:303-720-2005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3097225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist