Provider Demographics
NPI:1972894814
Name:BOTHAM, JENNIFER S (ND)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:BOTHAM
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 S BROADWAY STE 205
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-1547
Mailing Address - Country:US
Mailing Address - Phone:480-207-0427
Mailing Address - Fax:
Practice Address - Street 1:240 S BROADWAY STE 205
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209
Practice Address - Country:US
Practice Address - Phone:480-207-0427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000119175F00000X
AZ11-1243175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath