Provider Demographics
NPI:1780578922
Name:FRIEDRICHSEN, JACIE LEE
Entity type:Individual
Prefix:
First Name:JACIE
Middle Name:LEE
Last Name:FRIEDRICHSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 19TH ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-5924
Mailing Address - Country:US
Mailing Address - Phone:712-341-0265
Mailing Address - Fax:
Practice Address - Street 1:1900 N GRANT ST STE 600
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-4309
Practice Address - Country:US
Practice Address - Phone:844-445-1491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00099248631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical