Provider Demographics
NPI:1922248731
Name:JENNIFER WILLIAMS PC
Entity Type:Organization
Organization Name:JENNIFER WILLIAMS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAT
Authorized Official - Middle Name:J
Authorized Official - Last Name:OHEARN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-460-3233
Mailing Address - Street 1:4020 BOWSPRIT LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5670
Mailing Address - Country:US
Mailing Address - Phone:719-231-3053
Mailing Address - Fax:719-227-1042
Practice Address - Street 1:6270 LEHMAN DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1469
Practice Address - Country:US
Practice Address - Phone:719-231-3053
Practice Address - Fax:719-227-1042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2649103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty