Individual
JESSICA WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1455 DIXON AVE, LAFAYETTE, CO 80026-8879
(303) 443-8500
Mailing address
1647 ATWOOD ST, LONGMONT, CO 80501-2813
(203) 242-6550
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
CSW.09927029
CO
Other
Enumeration date
10/31/2019
Last updated
02/02/2021
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