Provider Demographics
NPI:1730759952
Name:SWANSON, JENNIFER (EDS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4034 S WISTERIA WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1714
Mailing Address - Country:US
Mailing Address - Phone:303-522-7643
Mailing Address - Fax:
Practice Address - Street 1:4034 S WISTERIA WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-1714
Practice Address - Country:US
Practice Address - Phone:303-522-7643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO333638103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool