Healthcare Provider Details

I. General information

NPI: 1801265509
Provider Name (Legal Business Name): JESSICA WHITNEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA HOLDEN

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4236 S HAMMOCK DR
COLORADO SPRINGS CO
80917-2004
US

IV. Provider business mailing address

4236 S HAMMOCK DR
COLORADO SPRINGS CO
80917-2004
US

V. Phone/Fax

Practice location:
  • Phone: 225-802-4844
  • Fax:
Mailing address:
  • Phone: 225-802-4844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09930125
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: