MEDICARE: DR. JENELL EFFINGER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY60448423	WA

General Provider Information

NPI Number	:	1518376102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENELL EFFINGER PH.D.

Provider Business Mailing Address
First Line	:	6075 S QUEBEC ST STE 200
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80111-4535
Country	:	US
Telephone Number	:	720-390-6932
Fax Number	:

Provider Business Practice Location Address
First Line	:	6075 S QUEBEC ST STE 200
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80111-4535
Country	:	US
Telephone Number	:	720-390-6932
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	11/08/2019

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