Healthcare Provider Details

I. General information

NPI: 1770783045
Provider Name (Legal Business Name): JILLIAN MICHELLE FRAZIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5412 IDYLWILD TRL
BOULDER CO
80301-3571
US

IV. Provider business mailing address

93 HAWK LN
BOULDER CO
80304-0421
US

V. Phone/Fax

Practice location:
  • Phone: 303-709-7101
  • Fax: 303-530-1517
Mailing address:
  • Phone: 303-709-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW530
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: