Jessica R Elack, RADT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

R1402020820 Issued in CA

Practice address

730 Sunrise Avenue
Building 200, Ste-201
Roseville, CA 95661

Phone

(916) 782-3737

NPI assigned

Aug 19, 2020

Last updated

Aug 19, 2020By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1597795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597795200000",
    "number": "1053923193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 SUNRISE AVENUE",
            "address_2": "BUILDING 200, STE-201",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "95661",
            "telephone_number": "916-782-3737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 SUNRISE AVENUE",
            "address_2": "BUILDING 200, STE-201",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "95661",
            "telephone_number": "916-782-3737"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1530 3rd St Ste 111",
            "address_purpose": "LOCATION",
            "city": "Lincoln",
            "state": "CA",
            "postal_code": "956482501",
            "country_code": "US",
            "telephone_number": "916-884-0015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELACK",
        "first_name": "JESSICA",
        "middle_name": "R",
        "credential": "RADT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-19",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "R1402020820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Roseville, CA
• Providers in Roseville, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; 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.