Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 769 | CO |
N | 103G00000X | Clinical Psychologist | 769 | CO |
N | 103TC0700X | Clinical Psychologist | 769 | CO |
Y | 103TM1800X | Intellectual & Developmental Disabilities | 769 | CO |
NPI | 1083908180 |
---|---|
Provider Name | Dr. Sharon S. Jacksi |
First Address | Grand Junction, CO 81507-8717 |
Second Address | Grand Junction, CO 81507-8717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2011 |
Last Update Date | 06/06/2011 |