Mary Yvette Jackson-Webb, LCSW,LAC,MAC,CIMHP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW09927388 Issued in CO

Practice address

2790 N Academy Blvd BLDG Suite206
Colorado Springs, CO 80917-5337

Phone

(719) 297-3499

NPI assigned

Apr 26, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

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": "1493164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1891220935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2790 N. ACADEMY BLVD.",
            "address_2": "SUITE #206",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809175328",
            "telephone_number": "719-297-3499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2790 N ACADEMY BLVD BLDG SUITE206",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809175337",
            "telephone_number": "719-297-3499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON-WEBB",
        "first_name": "MARY",
        "middle_name": "YVETTE",
        "name_prefix": "Mrs.",
        "credential": "LCSW,LAC,MAC,CIMHP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-04-26",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "CO",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "CSW09927388",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CO",
            "license": "LAC1914",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Michael Jack, D.D.S., M.S.
• Sharley Rene Jackman, RD
• Jacks Axe Throwing
• Kimberly A. Jacksi, RN
• Dell Ann Jackson-Golia
• Aimee C Jackson, MA, LPCC
• Andrea Jackson
• Caipriest Jackson
• Carla Jackson
• Charity L Jackson, M.D.

• Clinical Social Worker in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Clinical Social Worker in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 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.