Provider Demographics
NPI:1902139132
Name:ERICKSON CORNISH, JENNIFER A (PHD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:ERICKSON CORNISH
Suffix:
Gender:F
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF DENVER GSPP
Mailing Address - Street 2:2460 S. VINE STREET
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80208-0001
Mailing Address - Country:US
Mailing Address - Phone:303-871-4737
Mailing Address - Fax:303-871-4220
Practice Address - Street 1:1805 S BELLAIRE ST
Practice Address - Street 2:SUITE 500
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4305
Practice Address - Country:US
Practice Address - Phone:720-732-8556
Practice Address - Fax:303-790-2021
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO1138103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical