Healthcare Provider Details

I. General information

NPI: 1730052929
Provider Name (Legal Business Name): JACQUELINE WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 PENROSE PL STE 210
BOULDER CO
80301-1874
US

IV. Provider business mailing address

600 VIRIDIAN DR APT 319
LAFAYETTE CO
80026-7040
US

V. Phone/Fax

Practice location:
  • Phone: 720-588-3174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: