Active NPI
Jennifer Devorah Jackson, M.S.W.
- Clinical Social Worker
- Aurora, CO
National Provider Identifier
1104176288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 791 Chambers Rd
Aurora, CO 80011 - Phone
- (303) 617-2300
- Fax
- (303) 617-2397
- NPI assigned
- Sep 14, 2012
- Last updated
- Jun 9, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
791 Chambers Rd
Aurora, CO 80011
Mailing address
11059 E Bethany Dr
Ste 200
Aurora, CO 80014-2622
Phone (303) 617-2300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13520567 | Other | CO | CAQH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Collective Co LLC | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433808000000",
"number": "1104176288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11059 E BETHANY DR",
"address_2": "STE 200",
"city": "AURORA",
"state": "CO",
"postal_code": "800142622",
"telephone_number": "303-617-2300",
"fax_number": "303-617-2397"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "791 CHAMBERS RD",
"city": "AURORA",
"state": "CO",
"postal_code": "80011",
"telephone_number": "303-617-2300",
"fax_number": "303-617-2397"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JENNIFER",
"middle_name": "DEVORAH",
"name_prefix": "Mrs.",
"credential": "M.S.W.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-14",
"last_updated": "2015-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "13520567",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Aurora, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.