Healthcare Provider Details

I. General information

NPI: 1487499190
Provider Name (Legal Business Name): JENENNE M GUFFEY CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W 11TH ST
DELTA CO
81416-1811
US

IV. Provider business mailing address

PO BOX 1328
DURANGO CO
81302-1328
US

V. Phone/Fax

Practice location:
  • Phone: 970-252-3200
  • Fax:
Mailing address:
  • Phone: 970-335-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09930572
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: