Active NPI
Jill D Pollock, PSYD
- Psychologist
- Pueblo, CO
National Provider Identifier
1376614784
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2010
- Practice address
- 1115 N Grand Ave
Ste 100
Pueblo, CO 81003 - Phone
- (719) 562-4414
- Fax
- (719) 562-4415
- NPI assigned
- Nov 10, 2006
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2010 | CO | Primary |
Addresses
Primary practice location
1115 N Grand Ave
Ste 100
Pueblo, CO 81003
Mailing address
1115 N Grand Ave
Ste 100
Pueblo, CO 81003
Phone (719) 562-4414
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 035311 | Medicaid | CO |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2010 | CO | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376614784",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1115 N GRAND AVE",
"address_2": "STE 100",
"city": "PUEBLO",
"state": "CO",
"postal_code": "81003",
"telephone_number": "719-562-4414",
"fax_number": "719-562-4415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1115 N GRAND AVE",
"address_2": "STE 100",
"city": "PUEBLO",
"state": "CO",
"postal_code": "81003",
"telephone_number": "719-562-4414",
"fax_number": "719-562-4415"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLLOCK",
"first_name": "JILL",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CO",
"license": "2010",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "035311",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.