Healthcare Provider Details

I. General information

NPI: 1598296501
Provider Name (Legal Business Name): MS. JILLIAN O'LAUGHLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 S LOWELL BLVD APT 10-306
DENVER CO
80236-2400
US

IV. Provider business mailing address

3400 S LOWELL BLVD APT 10-306
DENVER CO
80236-2400
US

V. Phone/Fax

Practice location:
  • Phone: 720-427-2725
  • Fax:
Mailing address:
  • Phone: 720-427-2725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: