MEDICARE: JENNIFER SHEEDY LAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1184360109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SHEEDY LAC

Provider Business Mailing Address
First Line	:	1191 POPLAR ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-3045
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1191 POPLAR ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-3045
Country	:	US
Telephone Number	:	978-578-5579
Fax Number	:

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

Provider Enumeration Date	:	05/11/2022
Last Update Date	:	05/11/2022

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Directions to “ JENNIFER SHEEDY LAC” Practice Location

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