Provider Demographics
NPI:1386455467
Name:FOOTMAN, JENNIFER CELESTE (MSW, LSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CELESTE
Last Name:FOOTMAN
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CELESTE
Other - Last Name:HARTFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14530 WYANDOTT DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-2832
Mailing Address - Country:US
Mailing Address - Phone:719-985-5264
Mailing Address - Fax:
Practice Address - Street 1:9475 BRIAR VILLAGE PT STE 320
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7905
Practice Address - Country:US
Practice Address - Phone:719-985-5264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.00099260161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical