Provider Demographics
NPI:1255771424
Name:WOTKYNS, JEANETTE K (JD LMFT)
Entity type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:K
Last Name:WOTKYNS
Suffix:
Gender:F
Credentials:JD LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7880 E ELLSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6796
Mailing Address - Country:US
Mailing Address - Phone:303-519-7621
Mailing Address - Fax:
Practice Address - Street 1:7880 E ELLSWORTH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6796
Practice Address - Country:US
Practice Address - Phone:303-519-7621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001003106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist