Basic Information
| Provider Information | |||||||||
| NPI: | 1508831249 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OIKLE | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | PH D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2185 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802052534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032962244 | ||||||||
| FaxNumber: | 3032961709 | ||||||||
| Practice Location | |||||||||
| Address1: | 1297 S PERRY | ||||||||
| Address2: | BROOKSIDE INN | ||||||||
| City: | CASTLE ROCK | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801041977 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036882500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 2856 | CO | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 54934087 | 05 | CO | MEDICAID |