Provider Demographics
NPI:1740314111
Name:HARROD, JENNIFER (RXN , CNS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HARROD
Suffix:
Gender:F
Credentials:RXN , CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 IRIS AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2226
Mailing Address - Country:US
Mailing Address - Phone:303-443-8500
Mailing Address - Fax:303-443-9934
Practice Address - Street 1:1333 IRIS AVENUE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80027
Practice Address - Country:US
Practice Address - Phone:303-443-8500
Practice Address - Fax:303-443-9934
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71785101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04140091Medicaid
COC14009Medicare ID - Type UnspecifiedMEDICARE