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NPI Code Detail

MEDICARE: MRS. KRYSTINE NICOLE HOEFER JACKSON MA

MEDICARE: MRS. KRYSTINE NICOLE HOEFER JACKSON MA
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1811335656
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRYSTINE NICOLE HOEFER JACKSON MA
Provider Business Mailing Address
First Line : 1630 S ACOMA ST
Second Line :
City : DENVER
State : CO
Zip : 80223-3602
Country : US
Telephone Number : 303-777-9198
Fax Number :
Provider Business Practice Location Address
First Line : 1630 S ACOMA ST
Second Line :
City : DENVER
State : CO
Zip : 80223-3602
Country : US
Telephone Number : 303-777-9198
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2013
Last Update Date : 06/13/2013

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Directions to “ MRS. KRYSTINE NICOLE HOEFER JACKSON MA” Practice Location

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