MEDICARE: JENNIFER ANN THOMPSON CONSOLO

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1720763824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ANN THOMPSON CONSOLO

Provider Business Mailing Address
First Line	:	3768 NORWOOD DR STE 200-201
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80125-9710
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3768 NORWOOD DR STE 200-201
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80125-9710
Country	:	US
Telephone Number	:	720-491-8171
Fax Number	:

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

Provider Enumeration Date	:	06/16/2023
Last Update Date	:	06/16/2023

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