MEDICARE: JESSICA JANELLE COLBERT 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	1041C0700X	Clinical Social Worker	8861238	ID

General Provider Information

NPI Number	:	1972061059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA JANELLE COLBERT LCSW

Provider Business Mailing Address
First Line	:	7761 N 55TH E
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-5530
Country	:	US
Telephone Number	:	986-294-0262
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 SHOUP AVE STE 313
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83402-3650
Country	:	US
Telephone Number	:	986-294-0262
Fax Number	:

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

Provider Enumeration Date	:	03/07/2019
Last Update Date	:	02/10/2026

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