=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275255705
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEAN SUN WOO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2022
-----------------------------------------------------
Last Update Date | 12/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10699 MELODY DR STE 2
-----------------------------------------------------
City | NORTHGLENN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80234-4131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-398-9282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3817 S EAGLE ST
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80014-4105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-641-3358
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CSW.09928238
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------