Individual
JESSICA NITALEE MEDSKER LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, LAC
Contact information
Practice address
1860 EGBERT STREET, BRIGHTON, CO 80601
(303) 697-2583
Mailing address
777 BANNOCK ST, DENVER, CO 80204-4597
(720) 424-0156
(720) 424-0146
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
ACD.0001952
CO
1041C0700X
Clinical Social Worker
Primary
CSW.09926156
CO
1041S0200X
School Social Worker
CSW.09926156
CO
Other
Enumeration date
06/26/2017
Last updated
11/25/2024
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