Provider Demographics
NPI:1932830353
Name:WITTWER, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:WITTWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:LABRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 PENNY LN UNIT 812
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-8656
Mailing Address - Country:US
Mailing Address - Phone:720-909-9033
Mailing Address - Fax:
Practice Address - Street 1:3600 PENNY LN UNIT 812
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:CO
Practice Address - Zip Code:80620-8656
Practice Address - Country:US
Practice Address - Phone:720-909-9033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.00099234651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical