Active NPI
Jennifer Marie Wells, LCSW
- Clinical Social Worker
- Salem, OR
National Provider Identifier
1104232586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- L8286
- Practice address
- 200 Hawthorne Ave SE
Salem, OR 97301-5860 - Phone
- (971) 599-0793
- NPI assigned
- Jul 7, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Mental Health Counselor | 101YM0800X | |||
| Social Worker | 104100000X | |||
| Clinical Social Worker | 1041C0700X | L8286 | OR | Primary |
Addresses
Primary practice location
200 Hawthorne Ave SE
Salem, OR 97301-5860
Mailing address
1598 Alder Dr NE
Keizer, OR 97303-4018
Phone (971) 599-0793
Other practice location 1
1598 Alder Dr NE
Keizer, OR 97303-4018
Phone (971) 599-0793
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104232586 | Medicaid | OR |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L8286 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653696000000",
"number": "1104232586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1598 ALDER DR NE",
"city": "KEIZER",
"state": "OR",
"postal_code": "973034018",
"telephone_number": "971-599-0793"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 HAWTHORNE AVE SE",
"city": "SALEM",
"state": "OR",
"postal_code": "973015860",
"telephone_number": "971-599-0793"
}
],
"practiceLocations": [
{
"address_1": "1598 Alder Dr NE",
"address_purpose": "LOCATION",
"city": "Keizer",
"state": "OR",
"postal_code": "973034018",
"country_code": "US",
"telephone_number": "971-599-0793",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WELLS",
"first_name": "JENNIFER",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-07",
"last_updated": "2022-05-28",
"certification_date": "2022-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "L8286",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1104232586",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.