DR. COLLEEN MAGUIRE JACKSON (NPI# 1417384504) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417384504 |
| Entity Type | Individual |
| Full Name | DR. COLLEEN MAGUIRE JACKSON |
| Credential | PH.D. |
| Practice Address |
703 3rd St West Lafayette IN 47907-2081 |
| Practice Telephone | 7654946995 |
| Mailing Telephone | 7654946995 |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2015-04-28 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103T00000X | Psychologist | 20042613A | IN | Behavioral Health & Social Service Providers |
| Y | 103TC1900X |
Psychologist Specialization: Counseling |
20042613A | IN | Behavioral Health & Social Service Providers |
| Street Address |
703 3RD ST |
| City | WEST LAFAYETTE |
| State | IN |
| Zip Code | 47907-2081 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790283919 | Julie Lynn Beckwith | Psychologist | 703 3rd St, West Lafayette, IN 47907-2081 | 2018-01-23 |
| 1578990677 | Douglas Bennett | Psychologist | 703 3rd St, West Lafayette, IN 47907-2081 | 2013-10-03 |
| 1346677549 | Katheryne Kopp Miller | Psychologist | 703 3rd St, West Lafayette, IN 47907-2081 | 2013-10-02 |
| 1114354529 | Rebecca L Wong | Psychologist | 703 3rd St, Room 1120, West Lafayette, IN 47907-2081 | 2013-09-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285274464 | Christine Michelle Jones | Nurse Practitioner | Lyles-porter Hall 715 Clinic Drive, West Lafayette, IN 47907 | 2020-01-15 |
| 1013415033 | Brianna Johnson | Psychologist | 601 Stadium Mall Drive, Purdue University Student Health Center, 2nd Floor, West Lafayette, IN 47907 | 2018-01-24 |
| 1285095885 | Christina Ellen Manfred | Nurse Practitioner | 601 W. Stadium Ave, West Lafayette, IN 47907 | 2016-03-10 |
| 1265612626 | Anu Subramanian | Speech-Language Pathologist | 500 Oval Drive Purdue University, Dept of Speech Language and Hearing Sciences, West Lafayette, IN 47907 | 2007-11-13 |
| 1720163348 | Andrea Lynn Lopez | Specialist/Technologist | 900 N. University Ave, Room B63, West Lafayette, IN 47907 | 2006-10-25 |
| 1912914680 | Jeanette Stone Leonard | Audiologist | 715 Clinic Drive, Purdue University, West Lafayette, IN 47907 | 2006-08-02 |
| 1447224977 | Lindsey Ann Watson | Specialist/Technologist | 900 N University Dr, Mackey Arena, Room B60, West Lafayette, IN 47907 | 2006-02-13 |
| 1992280960 | Carol Callahan Lancaster | Nurse Practitioner | 601 Stadium Mall Drive, West Lafayette, IN 47907 | 2018-09-26 |
| 1104314046 | Lukas Micheal Passalacqua | Specialist/Technologist | 900 N John R Wooden Dr, West Lafayette, IN 47907 | 2018-04-26 |
| 1053712570 | Purdue Sports Medicine Wl | Internal Medicine | 900 John R Wooden Drive, Mackey Arena, West Lafayette, IN 47907 | 2014-09-16 |
| Find all providers in zip 47907 | ||||
| Taxonomy Code | 103TC1900X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Counseling |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821506163 | Christopher G Black | Psychologist | 703 3rd St Rm 1120, West Lafayette, IN 47907-2081 | 2018-01-22 |
| 1588811681 | Tianna Kyong Bertsch | Psychologist | 1330 Win Hentschel Blvd, West Lafayette, IN 47906-4149 | 2008-08-20 |
| 1215193339 | Angela Marotta Garrison | Psychologist | 703 Third Street Rm. 1120 Psyc, Purdue University Caps, West Lafayette, IN 47907-2081 | 2008-07-29 |
| 1740741750 | Modern Mental Health, Inc. | Psychologist | 1330 Win Hentschel Blvd, West Lafayette, IN 47906-4149 | 2019-03-31 |
| 1689172702 | Zhen Li | Psychologist | 601 Stadium Mall Dr, West Lafayette, IN 47907-2052 | 2018-01-23 |
| 1578990677 | Douglas Bennett | Psychologist | 703 3rd St, West Lafayette, IN 47907-2081 | 2013-10-03 |
| 1497182935 | Susan Lynn Prieto-welch | Psychologist | 601 Stadium Mall Dr, West Lafayette, IN 47907-2052 | 2013-09-30 |
| 1427299171 | Charity Elizabeth Tabol | Psychologist | 148 Sagamore Pkwy W, West Lafayette, IN 47906-1569 | 2009-03-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972125946 | Lesley Stockton | Psychologist | 3837 N Delaware St, Indianapolis, IN 46205-2647 | 2020-05-13 |
| 1316440191 | Julie D'argent | Psychologist | 205 N College Ave Ste 430, Bloomington, IN 47404 | 2018-03-17 |
| 1932632932 | Julie Renee Lafollette | Psychologist | 3901 E Hagan St, Suite F, Bloomington, IN 47401-8557 | 2017-04-06 |
| 1083155964 | The Highlands Psychology Group | Psychologist | 3100 John Hinkle Place Suite 104, Bloomington, IN 47408-2611 | 2017-03-13 |
| 1548705478 | Sarah Lagrange | Psychologist | 1918 S Hawksmoore Dr, Bloomington, IN 47401-7155 | 2017-01-02 |
| 1386013167 | Angela Janet Horn | Psychologist | 2627 Charlestown Road, New Albany, IN 47150 | 2015-09-22 |
| 1649648155 | Lenisha Watson | Psychologist | 3133 Merrick Ln, 1a, Indianapolis, IN 46222-1755 | 2015-09-14 |
| 1336534346 | Emily Marie Elder | Psychologist | 401 West Eads Parkway, Suite 450, Lawrenceburg, IN 47205 | 2015-04-06 |
| 1487065611 | Jesse Steinfeldt | Psychologist | 6309 Bent Pine Drive, Bloomington, IN 47408-9345 | 2014-05-09 |
| 1356776025 | Laura Michelle Oyer | Psychologist | 4150 Illinois Rd, Fort Wayne, IN 46804 | 2013-09-12 |
| Find all providers with the same taxonomy | ||||
| City | WEST LAFAYETTE |
| Zip Code | 47907 |
Please comment or provide details below to improve the information on DR. COLLEEN MAGUIRE JACKSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.