Provider Demographics
NPI:1366727927
Name:SCHWANDT, JERI JEAN
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:JEAN
Last Name:SCHWANDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 E DARTMOUTH AVE
Mailing Address - Street 2:APARTMENT O309
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4801
Mailing Address - Country:US
Mailing Address - Phone:720-327-5077
Mailing Address - Fax:
Practice Address - Street 1:9142 W KEN CARYL AVE
Practice Address - Street 2:UNIT D2
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-5252
Practice Address - Country:US
Practice Address - Phone:303-933-6153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10878225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist