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General NPI Number Information
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NPI Number | 1013563238
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Entity Type | Individual
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Provider Name | JESSICA JOANN MARS
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Gender | Female
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Dates
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Enumeration Date | 08/13/2019
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 1400 E BOULDER ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-5533
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Country | US
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Telephone | 719-365-8808
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Fax | 719-365-6101
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Provider Business Mailing Address
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Address Line | 317 HENRY AVE
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City | PUEBLO
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State | CO
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Zip | 81005-1312
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Country | US
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Telephone | 719-660-6709
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9925144
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License Number State | CO
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