Provider Demographics
NPI:1063093367
Name:SILS, JACQUELYNNE
Entity type:Individual
Prefix:
First Name:JACQUELYNNE
Middle Name:
Last Name:SILS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUELYNNE
Other - Middle Name:MARIE
Other - Last Name:STEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:424 JENKINS RANCH RD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-6546
Mailing Address - Country:US
Mailing Address - Phone:937-717-8812
Mailing Address - Fax:
Practice Address - Street 1:5585 ERINDALE DR STE 736
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6737
Practice Address - Country:US
Practice Address - Phone:719-696-3439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional