Mac Andrew Jack

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

CO-2847 Issued in CO

Practice address

2919 Valmont Rd
Ste 204
Boulder, CO 80301

Phone

(303) 938-1110

Fax

(303) 938-1145

NPI assigned

Oct 2, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wisdom Health PC

  dba Sky Health Services

  • Geriatric Medicine (Internal Medicine) Physician
  • Boulder, CO
  • NPI 1407187636
  NPD

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

{
    "created_epoch": "1727827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1225856867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2919 VALMONT RD",
            "address_2": "STE 204",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "80301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2919 VALMONT RD",
            "address_2": "STE 204",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "80301",
            "telephone_number": "303-938-1110",
            "fax_number": "303-938-1145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "MAC ANDREW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-10-02",
        "last_updated": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "CO-2847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Isabel Izawa, NBCMI #101196
• J K Hullett Incorporated
• J.C. Sleeper, LLC
• Sakinah Jaaber, MA
• John S Jachimiak, DPM
• Stanley K Jack, D.O.
• Cecilia Jackson
• David Paul Jackson, DDS
• Jennifer Jackson, MS, MFTC
• Stacy Marie Jackson, DDS

• Clinical Psychologist in Boulder, CO
• Providers in Boulder, CO by specialty
• Clinical Psychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2024; 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.