Provider Demographics
NPI:1255101440
Name:BOLTON, JENNIFER (RDN, IBCLC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BOLTON
Suffix:
Gender:F
Credentials:RDN, IBCLC
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:POWELL
Other - Last Name:BOLTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11983 SONG BIRD HILLS ST
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8687
Mailing Address - Country:US
Mailing Address - Phone:303-437-6961
Mailing Address - Fax:
Practice Address - Street 1:11983 SONG BIRD HILLS ST
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8687
Practice Address - Country:US
Practice Address - Phone:303-437-6961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
CO0893849133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN