=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619792777
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LESLIE NMN JORDAN PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2024
-----------------------------------------------------
Last Update Date | 11/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3955 EAST EXPOSITION AVE. SUITE 405
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-778-6500
-----------------------------------------------------
Fax | 303-517-7802
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3955 EAST EXPOSITION AVE. SUITE 405
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-778-6500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 405
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------