Provider Demographics
NPI:1366747545
Name:DIRDEN, JENNIFER LEA (CMT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEA
Last Name:DIRDEN
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 1:2418 E BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-2546
Mailing Address - Country:US
Mailing Address - Phone:303-655-8699
Mailing Address - Fax:
Practice Address - Street 1:11450 KING ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-7149
Practice Address - Country:US
Practice Address - Phone:303-359-9912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4346225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist