Individual
LORI ELLEN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, MFT
Contact information
Practice address
6625 W 26TH AVE, WHEAT RIDGE, CO 80214-8014
(720) 232-5908
Mailing address
6625 W 26TH AVE, WHEAT RIDGE, CO 80214-8014
(720) 232-5908
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
11888
CO
Other
Enumeration date
03/15/2010
Last updated
06/13/2011
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