Basic Information
| Provider Information | |||||||||
| NPI: | 1841710209 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LACKEY | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | NITALEE MEDSKER | ||||||||
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| Credential: | LCSW, LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 BANNOCK ST UNIT 1 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802044597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204235170 | ||||||||
| FaxNumber: | 7204235011 | ||||||||
| Practice Location | |||||||||
| Address1: | 1860 EGBERT STREET | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036972583 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2017 | ||||||||
| LastUpdateDate: | 08/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.