Provider Demographics
NPI:1194066845
Name:EUBANKS, JESSICA RAE (CMT)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:RAE
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 UTICA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2436
Mailing Address - Country:US
Mailing Address - Phone:303-829-4728
Mailing Address - Fax:
Practice Address - Street 1:6 W ARKANSAS AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-3225
Practice Address - Country:US
Practice Address - Phone:303-829-4728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0007886174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist