Healthcare Provider Details

I. General information

NPI: 1609380807
Provider Name (Legal Business Name): JESSICA SUSAN NELSEN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 W COYOTE DR
SILVERTHORNE CO
80498-9215
US

IV. Provider business mailing address

417 W COYOTE DR
SILVERTHORNE CO
80498-9215
US

V. Phone/Fax

Practice location:
  • Phone: 303-795-2715
  • Fax:
Mailing address:
  • Phone: 303-795-2715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09927320
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: