Healthcare Provider Details

I. General information

NPI: 1295384527
Provider Name (Legal Business Name): JESSICA VAN MARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 W JEFFERSON AVE STE 202
LAKEWOOD CO
80235-2023
US

IV. Provider business mailing address

3596 S DEPEW ST UNIT 7
LAKEWOOD CO
80235-2834
US

V. Phone/Fax

Practice location:
  • Phone: 303-225-7673
  • Fax:
Mailing address:
  • Phone: 952-452-3691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: