Most Relevant Information
Provider Data
| NPI Number: | 1003212200 |
| Provider Name: | JESSICA RENEE KUDLOCK LCSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | 09923361 |
Most Important Dates
| Enumeration Date: | 11/15/2014 |
| Last Updated: | 11/15/2014 |
Provider Practice Location
777 BANNOCK ST
DENVER
CO
802044507
Practice Location Phone/Fax
| Phone: | 3036027220 |
| Fax: | 3034367381 |
Provider Mailing Location
777 BANNOCK ST
DENVER
CO
802044507
Provider Mailing Phone/Fax
| Phone: | 3036027220 |
| Fax: | 3034367381 |