Jackie Ann Ebbert

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS10717 Issued in CA

Practice address

175 Bernal Rd Ste 140
San Jose, CA 95119-1343

Phone

(408) 972-3099

NPI assigned

Jan 4, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jacki Ann Ebbert Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033266796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 BERNAL RD STE 140",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951191343",
            "telephone_number": "408-972-3099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 BERNAL RD STE 140",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951191343",
            "telephone_number": "408-972-3099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBBERT",
        "first_name": "JACKIE",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS10717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKI",
            "last_name": "EBBERT",
            "middle_name": "ANN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Clinical Social Worker in San Jose, CA
• Providers in San Jose, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.