Provider Demographics
NPI:1821770108
Name:VERDUZCO, JAKE ALEXANDER
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:ALEXANDER
Last Name:VERDUZCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9123 E MISSISSIPPI AVE APT 8-104
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-6876
Mailing Address - Country:US
Mailing Address - Phone:612-735-4395
Mailing Address - Fax:
Practice Address - Street 1:9123 E MISSISSIPPI AVE APT 8-104
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-6876
Practice Address - Country:US
Practice Address - Phone:612-735-4395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor