Provider Demographics
NPI:1548478878
Name:JACKSON, ROSA MARIA
Entity type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:MARIA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:MARIA
Other - Last Name:VELAZQUEZ-GUTIERREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:24788 RED CLOUD DR
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-7133
Mailing Address - Country:US
Mailing Address - Phone:562-708-1728
Mailing Address - Fax:
Practice Address - Street 1:24788 RED CLOUD DR
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-7133
Practice Address - Country:US
Practice Address - Phone:562-708-1728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker