Healthcare Provider Details

I. General information

NPI: 1407475767
Provider Name (Legal Business Name): JESSICA GUENTHER, LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 30TH ST STE 208
BOULDER CO
80301-1239
US

IV. Provider business mailing address

2500 30TH ST STE 208
BOULDER CO
80301-1239
US

V. Phone/Fax

Practice location:
  • Phone: 720-795-5255
  • Fax: 720-302-1264
Mailing address:
  • Phone: 720-795-5255
  • Fax: 720-302-1264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JESSICA ANNE GUENTHER
Title or Position: OWNER
Credential: LCSW
Phone: 720-795-5255