MEDICARE: JESSICA WHITNEY LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW.09930125	CO

General Provider Information

NPI Number	:	1801265509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA WHITNEY LMSW

Provider Business Mailing Address
First Line	:	4236 S HAMMOCK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-2004
Country	:	US
Telephone Number	:	225-802-4844
Fax Number	:

Provider Business Practice Location Address
First Line	:	4236 S HAMMOCK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-2004
Country	:	US
Telephone Number	:	225-802-4844
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2015
Last Update Date	:	06/11/2026

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