Provider Demographics
NPI:1942542055
Name:DAVIS, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DAVIS
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:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:CO
Mailing Address - Zip Code:80542-0177
Mailing Address - Country:US
Mailing Address - Phone:303-329-0870
Mailing Address - Fax:303-394-0871
Practice Address - Street 1:209 MAIN STREET
Practice Address - Street 2:UNIT B
Practice Address - City:MEAD
Practice Address - State:CO
Practice Address - Zip Code:80542
Practice Address - Country:US
Practice Address - Phone:303-329-0870
Practice Address - Fax:303-394-0871
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW-657104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker