Healthcare Provider Details

I. General information

NPI: 1174729859
Provider Name (Legal Business Name): JESSICA PAUL M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 16TH ST
GREELEY CO
80631-5116
US

IV. Provider business mailing address

1864 36TH AVENUE CT
GREELEY CO
80634-2827
US

V. Phone/Fax

Practice location:
  • Phone: 303-656-5721
  • Fax:
Mailing address:
  • Phone: 303-656-5721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: