Provider Demographics
NPI:1669518486
Name:PARKER, JENNIFER LYN (LCSW)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYN
Last Name:PARKER
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 1:631 N WEBER ST
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-5002
Mailing Address - Country:US
Mailing Address - Phone:719-329-0056
Mailing Address - Fax:719-477-9695
Practice Address - Street 1:631 N WEBER ST
Practice Address - Street 2:SUITE 7A
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-5002
Practice Address - Country:US
Practice Address - Phone:719-329-0056
Practice Address - Fax:719-477-9695
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9928891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO533447Medicaid