Healthcare Provider Details

I. General information

NPI: 1003072513
Provider Name (Legal Business Name): STEPHENIE COMBS B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS STEPHENIE JACKSON

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 W DAVIES AVE N
LITTLETON CO
80120-5252
US

IV. Provider business mailing address

6409 S VINEWOOD ST #308
LITTLETON CO
80120-1812
US

V. Phone/Fax

Practice location:
  • Phone: 303-797-9420
  • Fax:
Mailing address:
  • Phone: 720-371-8593
  • 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: