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General NPI Number Information
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NPI Number | 1134604713
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Entity Type | Individual
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Provider Name | JILLIAN K JACKSON MA, RP
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Gender | Female
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Dates
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Enumeration Date | 09/28/2018
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 1600 SPECHT POINT RD # 130
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City | FORT COLLINS
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State | CO
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Zip | 80525-4311
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Country | US
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Telephone | 970-494-5891
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Fax |
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Provider Business Mailing Address
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Address Line | 3172 DRAGONFLY CT
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City | CASTLE ROCK
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State | CO
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Zip | 80109-8668
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Country | US
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Telephone | 303-475-9962
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0109021
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License Number State | CO
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