Healthcare Provider Details

I. General information

NPI: 1396654240
Provider Name (Legal Business Name): JORLYSE DICKENS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 S CIRCLE DR STE 100
COLORADO SPRINGS CO
80906-4139
US

IV. Provider business mailing address

897 TECHNOLOGY CT
COLORADO SPRINGS CO
80915-3631
US

V. Phone/Fax

Practice location:
  • Phone: 719-481-3518
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWC.0000002562
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: