Individual provider Active NPI

Emily Jankowski

  • Clinical Social Worker
  • Grand Rapids, MI
National Provider Identifier
1023474988
Registry record updated Nov 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801099067 Issued in MI
Practice address
320 Commerce Ave SW
Grand Rapids, MI 49503-4101
Phone
(616) 258-7599
Fax
(616) 222-4571
NPI assigned
Jan 7, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6801099067 MI Primary

Addresses

Primary practice location

320 Commerce Ave SW
Grand Rapids, MI 49503-4101

Mailing address

300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 455-5000

Other names 1

  • Emily Behm Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20180327000165 MI Practitioner - Clinical Social Worker 3375805666 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2015
Medicare assignment
May accept Medicare assignment
Group practices
Burke Group Counseling and Consulting Professionals LLCGroup PAC ID 6103190335, 16 clinicians

Practice addresses (Care Compare)

756 Fulton St W
Grand Rapids, MI 49504-6404
Phone (616) 222-0631

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801099067MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Rest Christian Mental Health Services CurrentSince Mar 6, 2018 Accepting new patients
Pine Rest Christian Mental Health Services Social Worker CurrentSince Mar 6, 2018 Accepting new patients
Burke Group Counseling & Consulting Professionals LLC Clinical CurrentSince Oct 15, 2020 Accepting new patients
David W Hamilton PSYD PLLC PastSince Oct 21, 2019 Accepting new patients

Locations

756 Fulton St W
Ste 201
Grand Rapids, MI 49504
Phone 6162220631 ext. 702

320 Commerce Ave SW
Grand Rapids, MI 49503
Phone (616) 222-4570

756 Fulton St W
Grand Rapids, MI 49504
Phone (616) 222-0631

300 68th St SE
Wyoming, MI 49548
Phone (616) 455-5000

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1452124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543190400000",
    "number": "1023474988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-455-5000",
            "fax_number": "616-455-5960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 COMMERCE AVE SW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034101",
            "telephone_number": "616-258-7599",
            "fax_number": "616-222-4571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANKOWSKI",
        "first_name": "EMILY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-07",
        "last_updated": "2018-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801099067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EMILY",
            "last_name": "BEHM",
            "credential": "LMSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.