Healthcare Provider Details

I. General information

NPI: 1174021166
Provider Name (Legal Business Name): JACOB COHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8850 W 38TH AVE APT 2028
WHEAT RIDGE CO
80033-4235
US

IV. Provider business mailing address

8850 W 38TH AVE STE D
WHEAT RIDGE CO
80033-4245
US

V. Phone/Fax

Practice location:
  • Phone: 970-614-5330
  • Fax:
Mailing address:
  • Phone: 970-614-5330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09932543
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: