Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ACD.0000784 | CO |
Y | 1041C0700X | Clinical Social Worker | CSW.09924859 | CO |
NPI | 1215323555 |
---|---|
Provider Name | Jessica Taylor Stone |
First Address | Denver, CO 80220-2415 |
Second Address | Denver, CO 80220-2415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2015 |
Last Update Date | 24/04/2019 |