Provider Demographics
NPI:1952618647
Name:ROBIRDS, JACKLYN JANE (LICENSED CLINICAL SO)
Entity Type:Individual
Prefix:MRS
First Name:JACKLYN
Middle Name:JANE
Last Name:ROBIRDS
Suffix:
Gender:F
Credentials:LICENSED CLINICAL SO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 PALMER ST.
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416
Mailing Address - Country:US
Mailing Address - Phone:970-250-2711
Mailing Address - Fax:
Practice Address - Street 1:423 PALMER ST.
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416
Practice Address - Country:US
Practice Address - Phone:970-250-2711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1308101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional