Jacob K Vickrey, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

9742056-3501 Issued in UT

Practice address

11748 S 3600 W Ste 3
South Jordan, UT 84095-5922

Phone

(801) 896-8133

NPI assigned

Nov 2, 2018

Last updated

Aug 16, 2024By the provider in NPPES

Sex

Male

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

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 1, 2023 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

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.

• Live Well Counseling Services PLLC

  • Clinical Social Worker
  • South Jordan, UT
  • NPI 1366079097
  Authorized official Same address or phone

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

{
    "created_epoch": "1541116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1053889501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14664 S WARD HILLS CIR",
            "city": "HERRIMAN",
            "state": "UT",
            "postal_code": "840961256",
            "telephone_number": "760-792-3671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11748 S 3600 W STE 3",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840955922",
            "telephone_number": "801-896-8133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICKREY",
        "first_name": "JACOB",
        "middle_name": "K",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-11-02",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "9742056-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rena Jean Vanzo, MS, LCGC
• Amie Sue Vargas, M.S., CCC-SLP
• Giselle Ivette Vazquez
• Gustavo Velasquez, MD
• Corey R Verostick, DPT, FAAOMPT
• Vida Health
• Richard C Vinson, PT
• Vitality Togo
• Viv Radiology, LLC (VIV Radiology)
• Huy Vu, LCSW

• Clinical Social Worker in South Jordan, UT
• Providers in South Jordan, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.