Provider Demographics
NPI:1801302625
Name:SAPERSTONE, JESSICA H (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:H
Last Name:SAPERSTONE
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 1:5016 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-4533
Mailing Address - Country:US
Mailing Address - Phone:970-443-3799
Mailing Address - Fax:
Practice Address - Street 1:315 CANYON AVE STE 2
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2676
Practice Address - Country:US
Practice Address - Phone:970-443-3799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00986031101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health