| Doctor Name: | MS. JACQUELINE SUE VANDENBOVENKAMP |
| NPI Number: | 1659588101 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA-LPC-ATR |
| License Number: | 3918 |
| Business Practice Address: | 4500 19th St Lot 190 Boulder, CO - 803040613 |
| Business Phone Number: | 3036412718 |
| Business Fax Number: | |
| Mailing Address: | 4500 19th St, Lot 190 BOULDER |
| State: | CO |
| Postal Code: | 803040613 |
| Phone Number: | 3036412718 |
| Fax Number: | |
| NPI Enumeration Date: | 05/16/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 3918 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |