Jill Alane Poppe Mackenzie, JD, LSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

S1451150 Issued in OH

Practice address

955 Congress Park Dr
Centerville, OH 45459-4009

Phone

(937) 269-3047

NPI assigned

Nov 6, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Jill Alane Poppe Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Juris Doctor

State licenses

Practice roles

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.

• National Youth Advocate Program, Inc

  • Community/Behavioral Health Agency
  • Canton, OH
  • NPI 1679721906
  NPD (past)
• National Youth Advocate Program, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Rockford, IL
  • NPI 1841943495
  NPD (past)

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

{
    "created_epoch": "1509926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728518400000",
    "number": "1033622691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "628 LOXWOOD LN",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454586301",
            "telephone_number": "952-240-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 CONGRESS PARK DR",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454594009",
            "telephone_number": "937-269-3047"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1219 Jefferson Ave",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "436045836",
            "country_code": "US",
            "telephone_number": "419-221-2821",
            "fax_number": "419-221-2824",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "118 W Jackson St",
            "address_purpose": "LOCATION",
            "city": "West Unity",
            "state": "OH",
            "postal_code": "435709643",
            "country_code": "US",
            "telephone_number": "419-221-2821",
            "fax_number": "419-221-2824",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3103 W Elm St",
            "address_purpose": "LOCATION",
            "city": "Lima",
            "state": "OH",
            "postal_code": "458052516",
            "country_code": "US",
            "telephone_number": "419-221-2821",
            "fax_number": "419-221-2824",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7573 Northam Dr",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454598716",
            "country_code": "US",
            "telephone_number": "952-240-6060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POPPE MACKENZIE",
        "first_name": "JILL",
        "middle_name": "ALANE",
        "credential": "JD, LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-06",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "S1451150",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S1451150",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "S1451150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILL",
            "last_name": "POPPE",
            "middle_name": "ALANE",
            "credential": "JD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Plastic Surgery Institute of Dayton, Inc
• Katherine Theresa Platoni, PSYD
• Bhavani Pokala, M.D.
• Gordon Pokorny, PHARM.D.
• Lucas Polley
• Talmage N Porter, MD
• Erin Poston, AT, ATC
• Samantha Powell
• Raenell J Poynter, APRN.CNP
• Shea Monique Poythress

• Clinical Social Worker in Centerville, OH
• Providers in Centerville, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2024; 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.