Active NPI
Jaclyn Grogan, LCSW
- Clinical Social Worker
- Missoula, MT
National Provider Identifier
1124678180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- BBH-LCSW-LIC-25464
- Practice address
- 2339 Classic CT
Missoula, MT 59801-1354 - Phone
- (406) 370-7211
- NPI assigned
- Sep 12, 2019
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | BBH-LCSW-LIC-25464 | MT | Primary |
Addresses
Primary practice location
2339 Classic CT
Missoula, MT 59801-1354
Mailing address
2339 Classic CT
Missoula, MT 59801-1354
Phone (406) 370-7211
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220503002204 | MT | Practitioner - Clinical Social Worker | 3779970116 | Practice locations: Missoula, MT |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
Missoula, MT 59801
Phone (406) 370-7211
2329 Classic CT
Missoula, MT 59801-1354
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BBH-LCSW-LIC-25464 | MT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568332800000",
"number": "1124678180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2339 CLASSIC CT",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598011354",
"telephone_number": "406-370-7211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2339 CLASSIC CT",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598011354",
"telephone_number": "406-370-7211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROGAN",
"first_name": "JACLYN",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-09-12",
"last_updated": "2019-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MT",
"license": "BBH-LCSW-LIC-25464",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Missoula, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.