Provider Demographics
NPI:1255567343
Name:HUMBRECHT, JENNIFER LYN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYN
Last Name:HUMBRECHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 BIRCHWOOD DR
Mailing Address - Street 2:#29
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1422
Mailing Address - Country:US
Mailing Address - Phone:303-941-5366
Mailing Address - Fax:
Practice Address - Street 1:3735 BIRCHWOOD DR
Practice Address - Street 2:#29
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1422
Practice Address - Country:US
Practice Address - Phone:303-941-5366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health