Provider Demographics
NPI:1487486627
Name:JESSICA R MADY
Entity type:Organization
Organization Name:JESSICA R MADY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-698-2378
Mailing Address - Street 1:2257 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4660
Mailing Address - Country:US
Mailing Address - Phone:970-698-2378
Mailing Address - Fax:
Practice Address - Street 1:2223 MAIN AVE STE 106
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4654
Practice Address - Country:US
Practice Address - Phone:970-698-2378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty