Provider Demographics
NPI:1891972170
Name:RHODA, JENNIFER L (PSYD, LP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:RHODA
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:LUCCHESI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81302-1328
Mailing Address - Country:US
Mailing Address - Phone:970-259-2169
Mailing Address - Fax:970-247-5255
Practice Address - Street 1:281 SAWYER DR STE 100
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-3409
Practice Address - Country:US
Practice Address - Phone:970-259-2169
Practice Address - Fax:970-247-5255
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004178103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical