Colleen M Jackson, EDD

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

199332 Issued in NY

Practice address

153 Woodbury Ave
Syracuse, NY 13206-1935

Phone

(315) 254-4884

NPI assigned

May 20, 2025

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1747699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747699200000",
    "number": "1043002553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 WOODBURY AVE",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132061935",
            "telephone_number": "315-254-4884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 WOODBURY AVE",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132061935",
            "telephone_number": "315-254-4884"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "960 Salt Springs Rd",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132241696",
            "country_code": "US",
            "telephone_number": "315-446-6250 x219",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "COLLEEN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "EDD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-05-20",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "CASAC-38078",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "199332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elio Jabra, MD
• Mary Margaret Jackowski, PHD OD
• Adrianne J Jackson
• Alexis Jackson
• Ashley Paredes Jackson, DO
• Daniel Jackson
• Dorshey Jackson, MD
• Geri Lynne Jackson, LMFT
• Melani D Jackson, LPN
• Ralph Jackson

• Licensed Practical Nurse in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.