Provider Demographics
NPI:1104049873
Name:KOST, JAIMELYN M (LSW)
Entity type:Individual
Prefix:
First Name:JAIMELYN
Middle Name:M
Last Name:KOST
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 ROSLYN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-1939
Mailing Address - Country:US
Mailing Address - Phone:414-412-4711
Mailing Address - Fax:
Practice Address - Street 1:13123 E 16TH AVE # B140
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-2070
Practice Address - Fax:720-777-7311
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0700397104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS0700397OtherLSW