Healthcare Provider Details

I. General information

NPI: 1962376301
Provider Name (Legal Business Name): MRS. JESSICA HULL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 10/24/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 BARNES RD STE 245
COLORADO SPRINGS CO
80917-1564
US

IV. Provider business mailing address

4479 SAMARITAN LOOP
COLORADO SPRINGS CO
80916-4546
US

V. Phone/Fax

Practice location:
  • Phone: 719-600-9455
  • Fax:
Mailing address:
  • Phone: 719-600-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW.0009926848
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: