Provider Demographics
NPI:1023324423
Name:MAST, JESSICA (CD(DONA), CLC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MAST
Suffix:
Gender:F
Credentials:CD(DONA), CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18356 E ARIZONA AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-4373
Mailing Address - Country:US
Mailing Address - Phone:720-339-1442
Mailing Address - Fax:
Practice Address - Street 1:18356 E ARIZONA AVE UNIT C
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-4373
Practice Address - Country:US
Practice Address - Phone:720-339-1442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
COALPP-35701174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula