| South Table Wellness | |
|
2550 Youngfield St # 4 Lakewood CO 80215-1033 | |
| (720) 324-7939 | |
| Not Available |
| Full Name | South Table Wellness |
|---|---|
| Speciality | Clinic/Center |
| Location | 2550 Youngfield St # 4, Lakewood, Colorado |
| Authorized Official Name and Position | Jaclyn Ripperger-harrell (MANAGING MEMBER) |
| Authorized Official Contact | 7203247939 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Table Wellness 2903 Lookout View Dr Golden CO 80401-2521 Ph: (720) 324-7939 | South Table Wellness 2550 Youngfield St # 4 Lakewood CO 80215-1033 Ph: (720) 324-7939 |
| NPI Number | 1386387975 |
|---|---|
| Provider Enumeration Date | 04/20/2022 |
| Last Update Date | 02/03/2024 |
| Certification Date | 02/03/2024 |
| Medicare PECOS PAC ID | 8426408972 |
|---|---|
| Medicare Enrollment ID | O20231222002676 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386387975 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jaclyn Ripperger-harrell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760027411 PECOS PAC ID: 9032538343 Enrollment ID: I20201005002793 |
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