Provider Demographics
NPI:1427557826
Name:BRIGHTHEART, JODI KIMBER
Entity Type:Individual
Prefix:
First Name:JODI KIMBER
Middle Name:
Last Name:BRIGHTHEART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:KIMBER
Other - Last Name:BRIGHTHEART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:5254 N GLENWOOD AVE APT L2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2273
Mailing Address - Country:US
Mailing Address - Phone:720-496-7887
Mailing Address - Fax:
Practice Address - Street 1:305 CARPENTER RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4248
Practice Address - Country:US
Practice Address - Phone:709-663-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT58.0125031041C0700X
IL149.0200691041C0700X
COCSW.099285911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical