Provider Demographics
NPI:1902005515
Name:BERRY, JACQUELINE D
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:D
Last Name:BERRY
Suffix:
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 1:511 MELODY LN
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-5009
Mailing Address - Country:US
Mailing Address - Phone:970-216-9860
Mailing Address - Fax:
Practice Address - Street 1:511 MELODY LN
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-5009
Practice Address - Country:US
Practice Address - Phone:970-216-9860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor