Individual provider Active NPI

Jackie Hallberg, LMSW

  • Clinical Social Worker
  • Muskegon, MI
National Provider Identifier
1073919320
Registry record updated Nov 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801085441 Issued in MI
Practice address
2700 Baker St FL 3
Muskegon, MI 49444-2157
Phone
(231) 737-1335
Fax
(231) 737-0534
NPI assigned
Nov 14, 2014
Last updated
Nov 14, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2014

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 6801085441 MI Primary

Addresses

Primary practice location

2700 Baker St FL 3
Muskegon, MI 49444-2157

Mailing address

2700 Baker St FL 3
Muskegon, MI 49444-2157
Phone (231) 737-1335

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801085441MIMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1415923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415923200000",
    "number": "1073919320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 BAKER ST FL 3",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494442157",
            "telephone_number": "231-737-1335",
            "fax_number": "231-737-0534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 BAKER ST FL 3",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494442157",
            "telephone_number": "231-737-1335",
            "fax_number": "231-737-0534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLBERG",
        "first_name": "JACKIE",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-14",
        "last_updated": "2014-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801085441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskegon, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2014; 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.