Provider Demographics
NPI:1467883058
Name:GLEASON, JILLIAN I
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:GLEASON
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MERIDIAN DR
Mailing Address - Street 2:123 AYLESWORTH HALL NW
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80523-0001
Mailing Address - Country:US
Mailing Address - Phone:970-491-6053
Mailing Address - Fax:
Practice Address - Street 1:800 MERIDIAN DR
Practice Address - Street 2:123 AYLESWORTH HALL NW
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80523-0001
Practice Address - Country:US
Practice Address - Phone:970-491-6053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health