Healthcare Provider Details

I. General information

NPI: 1699638569
Provider Name (Legal Business Name): JEANELLE RENEE GORDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 REDWING RD STE 316
FORT COLLINS CO
80526-2879
US

IV. Provider business mailing address

7330 ROYAL COUNTRY DOWN DR
WINDSOR CO
80550-7040
US

V. Phone/Fax

Practice location:
  • Phone: 970-217-7733
  • Fax:
Mailing address:
  • Phone: 970-217-7733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: