Provider Demographics
NPI:1265688949
Name:JACKSON, KAREN GAIL (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:GAIL
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 E 1ST AVE
Mailing Address - Street 2:SUITE 590
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5810
Mailing Address - Country:US
Mailing Address - Phone:303-257-0377
Mailing Address - Fax:
Practice Address - Street 1:3300 E 1ST AVE
Practice Address - Street 2:SUITE 590
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5810
Practice Address - Country:US
Practice Address - Phone:303-257-0377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2916103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical