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General NPI Number Information
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NPI Number | 1073138848
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Entity Type | Individual
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Provider Name | JESSICA LORRAINE PERRY LCSW, RN
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Gender | Female
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 18609 W 84TH PL
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City | ARVADA
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State | CO
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Zip | 80007-7199
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Country | US
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Telephone | 301-471-0836
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Fax |
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Provider Business Mailing Address
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Address Line | 18609 W 84TH PL
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City | ARVADA
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State | CO
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Zip | 80007-7199
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Country | US
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Telephone | 301-471-0836
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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 | 17477
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 1643548
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 09926701
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License Number State | CO
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