Healthcare Provider Details

I. General information

NPI: 1326567363
Provider Name (Legal Business Name): JILL FLODSTROM CAC II
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 11/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W HWY 50
SALIDA CO
81201
US

IV. Provider business mailing address

550 W HWY 50
SALIDA CO
81201-2238
US

V. Phone/Fax

Practice location:
  • Phone: 719-539-6502
  • Fax:
Mailing address:
  • Phone: 719-539-6502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACB.0008406
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: