Healthcare Provider Details

I. General information

NPI: 1588955603
Provider Name (Legal Business Name): JENNA R ROE B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2011
Last Update Date: 04/23/2011
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

4873 ECKERT CIR
CASTLE ROCK CO
80104-5430
US

V. Phone/Fax

Practice location:
  • Phone: 303-797-9420
  • Fax: 303-797-9358
Mailing address:
  • Phone: 720-951-0946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: