MEDICARE: JEANETTE WAXMONSKY PHD

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	103TC0700X	Clinical Psychologist	2767	CO

General Provider Information

NPI Number	:	1194812248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE WAXMONSKY PHD

Provider Business Mailing Address
First Line	:	2205 W 136TH AVE # 106-146
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80023-9306
Country	:	US
Telephone Number	:	303-578-2702
Fax Number	:

Provider Business Practice Location Address
First Line	:	7535 E HAMPDEN AVE # 407
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-4838
Country	:	US
Telephone Number	:	303-578-2702
Fax Number	:

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

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	07/12/2023

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