Healthcare Provider Details

I. General information

NPI: 1528372166
Provider Name (Legal Business Name): JESSICA C KINGSLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7125 CHERRY CREEK NORTH DR
DENVER CO
80224-2044
US

IV. Provider business mailing address

2608 OLD FAIR RD
GRAND ISLAND NE
68803-5271
US

V. Phone/Fax

Practice location:
  • Phone: 308-380-1756
  • Fax:
Mailing address:
  • Phone: 308-382-5297
  • Fax: 308-382-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number09924268
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1966
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberCSW.09924268
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09924268
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: