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General NPI Number Information
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NPI Number | 1497350425
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Entity Type | Individual
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Provider Name | JORDYN RUSSO LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 26 W DRY CREEK CIR
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City | LITTLETON
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State | CO
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Zip | 80120-8063
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Country | US
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Telephone | 720-608-8543
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Fax |
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Provider Business Mailing Address
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Address Line | 4379 S COORS CT
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City | MORRISON
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State | CO
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Zip | 80465-1052
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Country | US
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Telephone | 404-735-3240
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CSW09925701
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License Number State | CO
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