Active NPI
Jackie L Newsom, LSW
- Social Worker
- Pocatello, ID
National Provider Identifier
1124464318
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- LSW-32514
- Practice address
- 353 N 4TH Ave
Ste 110
Pocatello, ID 83201-6390 - Phone
- (208) 233-7832
- NPI assigned
- May 15, 2013
- 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-32514 | ID | Primary |
Addresses
Primary practice location
353 N 4TH Ave
Ste 110
Pocatello, ID 83201-6390
Mailing address
PO Box 4908
Pocatello, ID 83205-4908
Phone (208) 236-1600
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-32514 | ID | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1368576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1368576000000",
"number": "1124464318",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4908",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832054908",
"telephone_number": "208-236-1600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "353 N 4TH AVE",
"address_2": "STE 110",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832016390",
"telephone_number": "208-233-7832"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEWSOM",
"first_name": "JACKIE",
"middle_name": "L",
"credential": "LSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-05-15",
"last_updated": "2013-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "ID",
"license": "LSW-32514",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.