Healthcare Provider Details

I. General information

NPI: 1942942875
Provider Name (Legal Business Name): JAELYN DIANE HEDGES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9458 W 89TH CIR
WESTMINSTER CO
80021-4412
US

IV. Provider business mailing address

9458 W 89TH CIR
WESTMINSTER CO
80021-4412
US

V. Phone/Fax

Practice location:
  • Phone: 303-883-2289
  • Fax:
Mailing address:
  • Phone: 303-883-2289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number106004
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09932636
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number127532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: