Provider Demographics
NPI:1811737752
Name:HUNTZINGER, JERICHA
Entity type:Individual
Prefix:
First Name:JERICHA
Middle Name:
Last Name:HUNTZINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1493 OSAGE ST APT 419
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-2456
Mailing Address - Country:US
Mailing Address - Phone:614-965-8543
Mailing Address - Fax:
Practice Address - Street 1:7720 W JEFFERSON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235
Practice Address - Country:US
Practice Address - Phone:720-937-7895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician