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General NPI Number Information
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NPI Number | 1619534823
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Entity Type | Individual
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Provider Name | JENNIFER NACKERUD
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Gender | Female
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Dates
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Enumeration Date | 05/22/2019
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 9197 W 6TH AVE STE 1000
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City | LAKEWOOD
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State | CO
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Zip | 80215-5109
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Country | US
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Telephone | 303-233-3122
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Fax |
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Provider Business Mailing Address
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Address Line | 2971 W 119TH AVE UNIT 101
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City | WESTMINSTER
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State | CO
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Zip | 80234-2492
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Country | US
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Telephone |
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-20-43044
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License Number State | CO
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