Individual
JACQUELINE R ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, NCSP, LP
Contact information
Practice address
12303 AIRPORT WAY STE 125, BROOMFIELD, CO 80021-2729
(970) 310-3406
Mailing address
12303 AIRPORT WAY STE 125, BROOMFIELD, CO 80021-2729
(970) 310-3406
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY.0005796
CO
103TS0200X
School Psychologist
PSY.0005796
CO
Other
Enumeration date
06/07/2018
Last updated
07/31/2024
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