Provider Demographics
NPI:1336760388
Name:PECK, JENNIFER FAITH (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:FAITH
Last Name:PECK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1461 SHORT GRASS CT
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3521
Mailing Address - Country:US
Mailing Address - Phone:720-230-6928
Mailing Address - Fax:
Practice Address - Street 1:1461 SHORT GRASS CT
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-3521
Practice Address - Country:US
Practice Address - Phone:720-230-6928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099272471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical