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NPI Code Detail

MEDICARE: KIMBERLY BLUEJACKET

MEDICARE: KIMBERLY BLUEJACKET
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianCO

General Provider Information

NPI Number : 1225960503
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY BLUEJACKET
Provider Business Mailing Address
First Line : 2120 E LA SALLE ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80909-2218
Country : US
Telephone Number : 719-466-4809
Fax Number :
Provider Business Practice Location Address
First Line : 2120 E LA SALLE ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80909-2218
Country : US
Telephone Number : 719-466-4809
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2026
Last Update Date : 06/01/2026

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Directions to “ KIMBERLY BLUEJACKET ” Practice Location

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