Active NPI
Jodi Munson Phillips, LSW
- Social Worker
- Blackfoot, ID
National Provider Identifier
1104236652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- LSW 31343
- Practice address
- 150 S Broadway St
Blackfoot, ID 83221-2711 - Phone
- (208) 785-1326
- Fax
- (208) 785-1396
- NPI assigned
- May 6, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | LSW 31343 | ID | Primary |
Addresses
Primary practice location
150 S Broadway St
Blackfoot, ID 83221-2711
Mailing address
150 S Broadway St
Blackfoot, ID 83221-2711
Phone (208) 785-1326
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 |
|---|---|---|---|
| LSW 31343 | ID | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1399334400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399334400000",
"number": "1104236652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 S BROADWAY ST",
"city": "BLACKFOOT",
"state": "ID",
"postal_code": "832212711",
"telephone_number": "208-785-1326",
"fax_number": "208-785-1396"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 S BROADWAY ST",
"city": "BLACKFOOT",
"state": "ID",
"postal_code": "832212711",
"telephone_number": "208-785-1326",
"fax_number": "208-785-1396"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "JODI",
"middle_name": "MUNSON",
"credential": "LSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-05-06",
"last_updated": "2014-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "ID",
"license": "LSW 31343",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blackfoot, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.