Healthcare Provider Details

I. General information

NPI: 1386074003
Provider Name (Legal Business Name): JESSICA CHAMBERLAIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 GARDEN OF THE GODS RD STE 105
COLORADO SPRINGS CO
80907-3419
US

IV. Provider business mailing address

5550 SACRAMENTO PL
COLORADO SPRINGS CO
80917-3847
US

V. Phone/Fax

Practice location:
  • Phone: 720-320-1025
  • Fax:
Mailing address:
  • Phone: 719-731-6401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09928699
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.013090
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: