Provider Demographics
NPI:1023444130
Name:WAYMAN, JENNIFER L (LPC, CAC II)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:WAYMAN
Suffix:
Gender:F
Credentials:LPC, CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 OTTAWA CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2598
Mailing Address - Country:US
Mailing Address - Phone:970-231-6736
Mailing Address - Fax:
Practice Address - Street 1:1412 OTTAWA CT
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2598
Practice Address - Country:US
Practice Address - Phone:970-231-6736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB.0006956101YA0400X
COLPC.0012237101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)