Individual
JENNIFER R JACKSON-COLBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSCSW
Contact information
Practice address
25955 W 327TH ST, PAOLA, KS 66071-4920
(913) 557-9096
(913) 294-9247
Mailing address
PO BOX 677, OTTAWA, KS 66067-0677
(913) 557-9096
(913) 294-9247
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LSCSW 3733
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200439270B
—
KS
01
—
856986
MEDICARE
KS
Enumeration date
07/06/2006
Last updated
02/11/2013
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