Provider Demographics
NPI:1962549444
Name:KAUFFMAN, JILL L (PHD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:L
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4851 INDEPENDENCE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6711
Mailing Address - Country:US
Mailing Address - Phone:303-748-6955
Mailing Address - Fax:303-432-5530
Practice Address - Street 1:4851 INDEPENDENCE ST STE 100
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6711
Practice Address - Country:US
Practice Address - Phone:303-748-6955
Practice Address - Fax:303-432-5530
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2087103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC549878Medicare ID - Type Unspecified
COC7519Medicare PIN