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General NPI Number Information
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NPI Number | 1669020673
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Entity Type | Individual
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Provider Name | JASON LEDLIE LPC
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Gender | Male
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Dates
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Enumeration Date | 09/03/2019
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Last Update Date | 09/03/2019
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Provider Practice Location Address
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Address Line | 400 W MIDLAND AVE STE 200
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City | WOODLAND PARK
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State | CO
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Zip | 80863-3199
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Country | US
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Telephone | 719-922-3494
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Fax |
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Provider Business Mailing Address
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Address Line | 15463 W US HIGHWAY 24
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City | WOODLAND PARK
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State | CO
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Zip | 80863-8723
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Country | US
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Telephone | 979-417-8930
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC.0014559
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License Number State | CO
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