MEDICARE: DR. JESSICA GELLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TH0004X	Health Psychologist	PSY.0004716	CO

General Provider Information

NPI Number	:	1013300243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA GELLER

Provider Business Mailing Address
First Line	:	1600 GLENARM PL APT 1002
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-4315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 N LOGAN ST STE 101
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-3009
Country	:	US
Telephone Number	:	303-476-8165
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2015
Last Update Date	:	03/17/2018

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