MEDICARE: ELIZABETH KOLB-JACKSON

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	103K00000X	Behavior Analyst	0133000518	VA
2	103K00000X	Behavior Analyst	1-13-14939

Other Identifiers

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

General Provider Information

NPI Number	:	1992940100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH KOLB-JACKSON

Provider Business Mailing Address
First Line	:	4526 RIVERMIST DR
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-7163
Country	:	US
Telephone Number	:	803-972-4728
Fax Number	:

Provider Business Practice Location Address
First Line	:	1270 NORTH WICKHAM RD
Second Line	:	SUITE 13
City	:	MELBOURNE
State	:	FL
Zip	:	32935-8307
Country	:	US
Telephone Number	:	321-385-7734
Fax Number	:

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

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	03/27/2026

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