Healthcare Provider Details

I. General information

NPI: 1144632647
Provider Name (Legal Business Name): JENNIFER HUBBARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8175 SHERIDAN BLVD UNIT N
ARVADA CO
80003-1928
US

IV. Provider business mailing address

8175 SHERIDAN BLVD UNIT N
ARVADA CO
80003-1928
US

V. Phone/Fax

Practice location:
  • Phone: 303-557-0855
  • Fax: 720-336-3149
Mailing address:
  • Phone: 303-557-0855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09924612
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: