Provider Demographics
NPI:1518053776
Name:DOWNIE, JACKIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JACKIE
Middle Name:
Last Name:DOWNIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:DOWNIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 484
Mailing Address - Street 2:
Mailing Address - City:PINEDALE
Mailing Address - State:WY
Mailing Address - Zip Code:82941-0484
Mailing Address - Country:US
Mailing Address - Phone:307-367-4118
Mailing Address - Fax:
Practice Address - Street 1:219 EAST PINE STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:PINEDALE
Practice Address - State:WY
Practice Address - Zip Code:82941-0484
Practice Address - Country:US
Practice Address - Phone:307-367-4118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
ORL24251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR11888060OtherCAQH