Healthcare Provider Details

I. General information

NPI: 1376473868
Provider Name (Legal Business Name): MEGHAN JENNA WEI LAN JACKSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGHAN JACKSON LCSW

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4304 AUSTIN BLUFFS PKWY
COLORADO SPRINGS CO
80918-2932
US

IV. Provider business mailing address

4304 AUSTIN BLUFFS PKWY
COLORADO SPRINGS CO
80918-2932
US

V. Phone/Fax

Practice location:
  • Phone: 719-445-9877
  • Fax:
Mailing address:
  • Phone: 719-445-9877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09923803
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: