Provider Demographics
NPI:1356770705
Name:BARTLEY, JESSICA DALE (PSYD, LCSW)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:DALE
Last Name:BARTLEY
Suffix:
Gender:F
Credentials:PSYD, LCSW
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:COREY
Other - Last Name:DALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2450 S. VINE STREET
Mailing Address - Street 2:ROOM 209
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80208
Mailing Address - Country:US
Mailing Address - Phone:720-663-0180
Mailing Address - Fax:
Practice Address - Street 1:2450 S VINE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5264
Practice Address - Country:US
Practice Address - Phone:303-871-6087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4018103TE1100X
CO99232511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical