MEDICARE: MRS. JESSICA C KINGSLEY LCSW

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
1	101YM0800X	Mental Health Counselor	09924268	CO
2	101YM0800X	Mental Health Counselor	1966	NE
3	1041S0200X	School Social Worker	CSW.09924268	CO
4	1041C0700X	Clinical Social Worker	CSW.09924268	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	099629	OTHER	NE	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528372166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA C KINGSLEY LCSW

Provider Business Mailing Address
First Line	:	2608 OLD FAIR RD
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-5271
Country	:	US
Telephone Number	:	308-382-5297
Fax Number	:	308-382-5315

Provider Business Practice Location Address
First Line	:	7125 CHERRY CREEK NORTH DR
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80224-2044
Country	:	US
Telephone Number	:	308-380-1756
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2010
Last Update Date	:	05/28/2024

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Directions to “ MRS. JESSICA C KINGSLEY LCSW” Practice Location

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