Individual
MR. JEFF R KISICKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2480 W 26TH AVE STE 130B, DENVER, CO 80211-5327
(303) 433-0188
Mailing address
2480 W 26TH AVE STE 130B, DENVER, CO 80211-5327
(303) 433-0188
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
LCSW # 992298
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-1516883
CORPORATE TAX ID #
CO
Enumeration date
02/12/2009
Last updated
02/12/2009
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