Provider Demographics
NPI:1952445462
Name:CHASE-JACOBSEN, JUDITH LYNNE (LCSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LYNNE
Last Name:CHASE-JACOBSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JAYLYNNE
Other - Middle Name:LYNNE
Other - Last Name:CHASE-JACOBSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:990 POPLAR AVENUE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304
Mailing Address - Country:US
Mailing Address - Phone:303-444-8969
Mailing Address - Fax:303-442-6612
Practice Address - Street 1:990 POPLAR AVENUE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304
Practice Address - Country:US
Practice Address - Phone:303-444-8969
Practice Address - Fax:303-442-6612
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9895431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical