1043380405 NPI number — JEANIE HELEN ROTHENMAIER L.P.C.

Table of content: JEANIE HELEN ROTHENMAIER L.P.C. (NPI 1043380405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043380405 NPI number — JEANIE HELEN ROTHENMAIER L.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROTHENMAIER
Provider First Name:
JEANIE
Provider Middle Name:
HELEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.P.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043380405
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3154 SULKY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERGREEN
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80439-8623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-674-7127
Provider Business Mailing Address Fax Number:
303-384-3220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
607 10TH ST STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOLDEN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80401-1053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-562-4906
Provider Business Practice Location Address Fax Number:
303-384-3220
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  821 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RO64039 . This is a "ANTHEM BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 140456 . This is a "COMPSYCH" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 077349000 . This is a "MAGELLAN BEHAVIORAL HEALTH" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 2068691 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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