Healthcare Provider Details

I. General information

NPI: 1013704485
Provider Name (Legal Business Name): JASON KRIESE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 INVERNESS CIR E UNIT N104
ENGLEWOOD CO
80112-5529
US

IV. Provider business mailing address

88 INVERNESS CIR E UNIT N104
ENGLEWOOD CO
80112-5529
US

V. Phone/Fax

Practice location:
  • Phone: 720-504-2138
  • Fax:
Mailing address:
  • Phone: 720-504-2138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: