Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist |
NPI | 1003342304 |
---|---|
Provider Name | Jessica Bauer |
First Address | Greenwood Village, CO 80112-1436 |
Second Address | Greenwood Village, CO 80112-1436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2017 |
Last Update Date | 04/05/2017 |