Provider Demographics
NPI:1104158906
Name:DOUGLASS, JENNIFER JOANNE (LAC, MSOM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOANNE
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5191 S YOSEMITE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3305
Mailing Address - Country:US
Mailing Address - Phone:303-669-4529
Mailing Address - Fax:
Practice Address - Street 1:5191 S YOSEMITE ST
Practice Address - Street 2:SUITE B
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-3305
Practice Address - Country:US
Practice Address - Phone:303-669-4529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1338171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist