Jennifer R Jackson-Colburn, LSCSW
Individual provider Active NPI Clinical Social Worker · Paola, KS
NPI 1497787154 · NPPES record last updated Feb 11, 2013
Key facts
- NPI
- 1497787154
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- LSCSW 3733 (KS)
- Practice address
- 25955 W 327TH St
Paola, KS 66071-4920 - Phone
- (913) 557-9096
- Fax
- (913) 294-9247
- NPI assigned
- Jul 6, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LSCSW 3733 | KS | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elizabeth Layton Center, Inc. | Past |
Accepting new patients | |
| Johnson County Mental Health Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LSCSW 3733 | KS | Yes |
Addresses
Primary practice location
25955 W 327TH St
Paola, KS 66071-4920
Mailing address
PO Box 677
Ottawa, KS 66067-0677
Phone (913) 557-9096
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200439270B | Medicaid | KS | |
| 856986 | Other | KS | MEDICARE |
Other providers in Paola, KS
- Hope Counseling Services LLC
- Travis L Howard
- Jean Marie Hoyt
- Robin L Huffman
- Blaire E Hunt-Lobdell
- Hannah January
- Jeff Wilson Chiropractic, Inc
- Jennie Jennings
- Alex R Johnson
- Donna R Johnson
All providers in Paola, KS · Clinical Social Worker in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.