Jacqueline Suzanne Hendrickson

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

License

13683 Issued in CO

Practice address

1740 S College Ave
Fort Collins, CO 80525-1009

Phone

(970) 472-1207

NPI assigned

Mar 8, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Jacqueline Roberts Former name

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": "1362700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369958400000",
    "number": "1912248394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1740 S COLLEGE AVE",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805251009",
            "telephone_number": "970-472-1207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 S COLLEGE AVE",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805251009",
            "telephone_number": "970-472-1207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKSON",
        "first_name": "JACQUELINE",
        "middle_name": "SUZANNE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-03-08",
        "last_updated": "2013-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "CO",
            "license": "13683",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "CO",
            "license": "13683",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "ROBERTS",
            "credential": "MA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kenyatta Henderson, IOMT
• Sandra Elizabeth Henderson, M.D.
• James D Hendrick, MD
• Jennifer M Hendrick, MD
• Debra Michelle Hendricks, LMT, C.N.A, AAS
• Susan D Hendrickson, LCSW
• Stephen Gerard Henke, M.D.
• Evelyn Henning
• Meaghan Hennings, LCSW
• Cassandra Lee Henry

• Adolescent and Children Mental Health Clinic/Center in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Adolescent and Children Mental Health Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2013; 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.