Provider Demographics
NPI:1194973792
Name:JAQUESS, KIMBERLY SUE (MA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUE
Last Name:JAQUESS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5080 MARK DABLING BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3833
Mailing Address - Country:US
Mailing Address - Phone:719-532-0151
Mailing Address - Fax:
Practice Address - Street 1:5080 MARK DABLING BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3833
Practice Address - Country:US
Practice Address - Phone:719-532-0151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health