Provider Demographics
NPI:1528177318
Name:FRITZLER, JENNIFER THOMAS (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:THOMAS
Last Name:FRITZLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11585 DEWEY ST
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-3913
Mailing Address - Country:US
Mailing Address - Phone:970-380-7234
Mailing Address - Fax:970-867-7234
Practice Address - Street 1:324 E RAILROAD AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3145
Practice Address - Country:US
Practice Address - Phone:970-867-7234
Practice Address - Fax:970-867-7234
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9894961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86846Medicare ID - Type UnspecifiedMEDICARE