Provider Demographics
NPI:1992521413
Name:CUNNINGHAM, JAEL (CMI)
Entity type:Individual
Prefix:
First Name:JAEL
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:CMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 VALMONT RD LOT 11
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2926
Mailing Address - Country:US
Mailing Address - Phone:720-336-0122
Mailing Address - Fax:
Practice Address - Street 1:5505 VALMONT RD LOT 11
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2926
Practice Address - Country:US
Practice Address - Phone:303-204-2671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-30
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103595171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter