Individual
MRS. JACQUELINE SUZANNE HENDRICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1740 S COLLEGE AVE, FORT COLLINS, CO 80525-1009
(970) 472-1207
Mailing address
1740 S COLLEGE AVE, FORT COLLINS, CO 80525-1009
(970) 472-1207
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
13683
CO
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
13683
CO
Other
Enumeration date
03/08/2013
Last updated
05/31/2013
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