Provider Demographics
NPI:1427302785
Name:STEVENSON, JENNIFER D (LAC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:D
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 XAVIER ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2231
Mailing Address - Country:US
Mailing Address - Phone:720-432-7073
Mailing Address - Fax:
Practice Address - Street 1:4423 W 43RD AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-2430
Practice Address - Country:US
Practice Address - Phone:720-432-7073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1791171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist