Provider Demographics
NPI:1972792802
Name:DENNIG, JON EASTON
Entity type:Individual
Prefix:
First Name:JON
Middle Name:EASTON
Last Name:DENNIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 E EXPOSITION AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209
Mailing Address - Country:US
Mailing Address - Phone:303-519-9479
Mailing Address - Fax:303-871-0992
Practice Address - Street 1:3955 E EXPOSITION AVE
Practice Address - Street 2:SUITE 408
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209
Practice Address - Country:US
Practice Address - Phone:303-519-9479
Practice Address - Fax:303-871-0992
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3515103G00000X, 103TC0700X
CO797106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical