Healthcare Provider Details

I. General information

NPI: 1295770758
Provider Name (Legal Business Name): JENNIFER BUGG WRIGHT PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/21/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 QUINCE ORCHARD BLVD STE Q
GAITHERSBURG MD
20878-1676
US

IV. Provider business mailing address

12504 E LASALLE PL
AURORA CO
80014-1924
US

V. Phone/Fax

Practice location:
  • Phone: 303-257-6880
  • Fax: 303-257-6880
Mailing address:
  • Phone: 303-257-6880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2670
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5331
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2670
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number2670
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number2670
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number2670
License Number StateCO
# 7
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number5531
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: