MEDICARE: JENNIFER NOONAN LPC, CACIII, CEAP

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1255661443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER NOONAN LPC, CACIII, CEAP

Provider Business Mailing Address
First Line	:	191 UNIVERSITY BLVD
Second Line	:	STE 124
City	:	DENVER
State	:	CO
Zip	:	80206-4613
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 UNIVERSITY BLVD
Second Line	:	STE 124
City	:	DENVER
State	:	CO
Zip	:	80206-4613
Country	:	US
Telephone Number	:	720-217-3831
Fax Number	:

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

Provider Enumeration Date	:	01/11/2010
Last Update Date	:	02/20/2011

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