Healthcare Provider Details

I. General information

NPI: 1912103656
Provider Name (Legal Business Name): JENNIFER ANN KELLY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER HUTCHISON

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4798 ESSEX CIR
BOULDER CO
80301-4136
US

IV. Provider business mailing address

4798 ESSEX CIR
BOULDER CO
80301-4136
US

V. Phone/Fax

Practice location:
  • Phone: 303-875-7340
  • Fax:
Mailing address:
  • Phone: 303-875-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149012043
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09932903
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: