Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | NLC.0107681 | CO |
Y | 103T00000X | Psychologist | NLC.0107681 | CO |
NPI | 1013405893 |
---|---|
Provider Name | Jessica Fern Cooley |
First Address | Boulder, CO 80304-4108 |
Second Address | Boulder, CO 80304-4108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2018 |
Last Update Date | 26/04/2018 |