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NPI Code Detail

MEDICARE: JENNIFER CELESTE FOOTMAN MSW, LSW

MEDICARE: JENNIFER CELESTE FOOTMAN MSW, LSW
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
1104100000XSocial WorkerLSW.0009926016CO

General Provider Information

NPI Number : 1386455467
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER CELESTE FOOTMAN MSW, LSW
Provider Business Mailing Address
First Line : 14530 WYANDOTT DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80908-2832
Country : US
Telephone Number : 719-985-5264
Fax Number :
Provider Business Practice Location Address
First Line : 9475 BRIAR VILLAGE PT STE 320
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80920-7905
Country : US
Telephone Number : 719-985-5264
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2025
Last Update Date : 07/01/2026

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