Provider Demographics
NPI:1912215666
Name:PFEIFFER, JESSICA PAOLA (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:PAOLA
Last Name:PFEIFFER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 VANCE ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-4829
Mailing Address - Country:US
Mailing Address - Phone:515-460-4446
Mailing Address - Fax:
Practice Address - Street 1:15000 W 72ND AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-7537
Practice Address - Country:US
Practice Address - Phone:515-460-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW000014001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000196597Medicaid