Provider Demographics
NPI:1699579813
Name:GOODLOE, JAYLIN
Entity type:Individual
Prefix:
First Name:JAYLIN
Middle Name:
Last Name:GOODLOE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2271 CLINTON ST UNIT 3306
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-1063
Mailing Address - Country:US
Mailing Address - Phone:601-317-3955
Mailing Address - Fax:
Practice Address - Street 1:1301 E COLFAX AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-2212
Practice Address - Country:US
Practice Address - Phone:601-317-3955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)