Provider Demographics
NPI:1891827994
Name:FETHERLING, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:FETHERLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E 16TH AVE
Mailing Address - Street 2:BOX 4
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-5195
Mailing Address - Country:US
Mailing Address - Phone:303-813-4265
Mailing Address - Fax:303-813-4261
Practice Address - Street 1:25 E 16TH AVE
Practice Address - Street 2:BOX 4
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-5195
Practice Address - Country:US
Practice Address - Phone:303-813-4265
Practice Address - Fax:303-813-4261
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health