Healthcare Provider Details

I. General information

NPI: 1740468826
Provider Name (Legal Business Name): JENNIFER GRACE KOCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4495 HALE PKWY STE 307
DENVER CO
80220-6204
US

IV. Provider business mailing address

4495 HALE PKWY STE 307
DENVER CO
80220-6204
US

V. Phone/Fax

Practice location:
  • Phone: 720-234-8163
  • Fax:
Mailing address:
  • Phone: 720-234-8163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.00000636
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: