Provider Demographics
NPI:1659181782
Name:RADFORD, JESSICA H (ED, EDS)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:H
Last Name:RADFORD
Suffix:
Gender:F
Credentials:ED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3537 VALLEYWOOD CT
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-4180
Mailing Address - Country:US
Mailing Address - Phone:402-350-1608
Mailing Address - Fax:
Practice Address - Street 1:3537 VALLEYWOOD CT
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-4180
Practice Address - Country:US
Practice Address - Phone:402-350-1608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17108216103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool