Jennifer Marie Wickersham, L.P.C.

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

002754 Issued in MO

Practice address

69 Turf CT
Webster Groves, MO 63119-4619

Phone

(314) 651-2179

NPI assigned

Feb 8, 2011

Last updated

May 31, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Networks

• devoted network organization-2b183dd2-4e80-4977-80a6-4fdf0df4361d
• IA HMO C-SNP
• IA HMO

Interoperability endpoints

• Direct secure messaging: jenniferwickersham@tdh.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717113600000",
    "number": "1023314168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 TURF CT",
            "city": "WEBSTER GROVES",
            "state": "MO",
            "postal_code": "631194619",
            "telephone_number": "314-651-2179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 TURF CT",
            "city": "WEBSTER GROVES",
            "state": "MO",
            "postal_code": "631194619",
            "telephone_number": "314-651-2179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKERSHAM",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "L.P.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-02-08",
        "last_updated": "2024-05-31",
        "certification_date": "2024-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "002754",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Scott Wenzel, DMD
• Sharon Whalen, D.C.
• Gina Maria White, RDH
• Michael A White, DDS
• Jason Wibbenmeyer, D.C.
• Justin Wilkinson, OD
• Kristan M Wilson, DC
• Tanya Marie Windmiller, DENTAL ASSISTANT
• Karlye Wojton
• Kristin Wright, LMFT, PH.D.

• Professional Counselor in Webster Groves, MO
• Providers in Webster Groves, MO by specialty
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.