Individual ProviderColleen C JacksonMarriage & Family TherapistBehavioral Health & Social Service ProvidersPractice Address2350 Professional Dr, Santa Rosa, CA 95403-3018(707) 565-7479PECOS EnrollmentBased on the most recent information from CMS, provider Colleen C Jackson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 1:08 PM.Profile DetailsProvider ID1891137444Provider TypeIndividualFull NameJackson, Colleen CGenderFemaleSole ProprietorNoEnumeration Date7/24/2013Last Updated5/1/2025Contact InformationPractice LocationPractice Address2350 Professional Dr, Santa Rosa, CA 95403-3018Phone(707) 565-7479FaxUnlisted FaxMailing LocationMailing Address1430 Neotomas Ave, Santa Rosa, CA 95405-7575Phone(707) 565-7479FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode106H00000XPrimaryDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicense84465California