Provider Demographics
NPI:1184242570
Name:PETERSON, JENNIFER JEAN (MSW, LSW)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JEAN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8545 W DAKOTA AVE APT B106
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3058
Mailing Address - Country:US
Mailing Address - Phone:720-577-5502
Mailing Address - Fax:
Practice Address - Street 1:8545 W DAKOTA AVE APT B106
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3058
Practice Address - Country:US
Practice Address - Phone:720-577-5502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-11
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 101YM0800X
COLSW.0009924588104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health