Provider Demographics
NPI:1770923161
Name:LAWTER, JENNIFER ANN (MA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:LAWTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 BLUESTEM DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-1305
Mailing Address - Country:US
Mailing Address - Phone:719-393-2041
Mailing Address - Fax:
Practice Address - Street 1:17 FARRAGUT AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5625
Practice Address - Country:US
Practice Address - Phone:719-393-2041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health