Jennifer L Bouldry, LCSW | |
50 Buck Creek Road, Suite 200, Avon, CO 81620-4330 | |
(970) 926-6340 | |
(970) 926-6348 |
Full Name | Jennifer L Bouldry |
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Gender | Female |
Speciality | Social Worker - Clinical |
Location | 50 Buck Creek Road, Avon, Colorado |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1164824207 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | MC15031 (Maine) | Secondary |
1041C0700X | Social Worker - Clinical | 09926807 (Colorado) | Primary |
Entity Name | Portland Community Health Center |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1609120856 PECOS PAC ID: 5395998017 Enrollment ID: O20130206000120 |
Mailing Address | Practice Location Address |
---|---|
Jennifer L Bouldry, LCSW 50 Buck Creek Rd, Suite 200, Avon, CO 81620 Ph: (970) 926-6340 | Jennifer L Bouldry, LCSW 50 Buck Creek Road, Suite 200, Avon, CO 81620-4330 Ph: (970) 926-6340 |
Marissa Josub, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 230 Chapel Sq Unit D-102, Avon, CO 81620 Phone: 970-945-2840 Fax: 970-945-2893 | |
Amanda Sharree Parsons, LCSW Clinical Social Worker Medicare: Accepting Medicare Assignments Practice Location: 50 Buck Creek Rd Ste 200, Avon, CO 81620 Phone: 970-926-6340 Fax: 970-926-6348 | |
Ms. Jill Sarah Zimmerman, M.S.W., LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 48 E. Beaver Creek Blvd., Ste. 209, Avon, CO 81620 Phone: 970-949-0404 Fax: 970-479-0731 |