Provider Demographics
NPI:1962808543
Name:FRAZIER, JESSICA TERRICE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:TERRICE
Last Name:FRAZIER
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:PO BOX 202644
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-8644
Mailing Address - Country:US
Mailing Address - Phone:720-275-5485
Mailing Address - Fax:
Practice Address - Street 1:390 S POTOMAC WAY STE C
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2491
Practice Address - Country:US
Practice Address - Phone:720-432-1509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099235901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0Medicaid