Provider Demographics
NPI:1407979602
Name:RESNICK, JOANNA MICHELLE (LAC)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:MICHELLE
Last Name:RESNICK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11257 W 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-2705
Mailing Address - Country:US
Mailing Address - Phone:303-505-9060
Mailing Address - Fax:
Practice Address - Street 1:3801 E FLORIDA AVE STE 915
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-2549
Practice Address - Country:US
Practice Address - Phone:303-505-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2024-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2377171100000X
COACU.0001870171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist