Provider Demographics
NPI:1659013753
Name:JACKSON, KAYLA (LCSW)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S BUCKLEY RD
Mailing Address - Street 2:STE 1 #161
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017
Mailing Address - Country:US
Mailing Address - Phone:720-509-9277
Mailing Address - Fax:
Practice Address - Street 1:1250 SOUTH BUCKLEY ROAD
Practice Address - Street 2:STE 1 #161
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-8001
Practice Address - Country:US
Practice Address - Phone:720-509-9277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099275521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical