Angela L Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149013402 Issued in IL

Practice address

404 W Green St
Urbana, IL 61801-3267

Phone

(217) 706-5498

NPI assigned

Nov 23, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2005

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jackson Therapy

  • Clinical Social Worker
  • Urbana, IL
  • NPI 1164080693
  Medicare reassignment NPD Authorized official
• Dulski Counseling, LLC

  • Mental Health Counselor
  • Champaign, IL
  • NPI 1902777659

  Clinical

  NPD

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

{
    "created_epoch": "1322006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615766400000",
    "number": "1144597899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 W GREEN ST",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618013267",
            "telephone_number": "217-398-9066",
            "fax_number": "217-398-9077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 W GREEN ST",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618013267",
            "telephone_number": "217-706-5498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANGELA",
        "middle_name": "L",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-23",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149013402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanner Alexander Israel
• Judith Ann Iversen, M.A
• J&C Psychotherapy Services Inc
• Jackson Therapy
• Amber A Jackson, NP
• Ellen Jacobsen, M.D.
• Shaza Imad Jafri, M.B.B.S
• Syed Ahmed Waqar Jafri, D.O
• Sanjiv Jain, MD
• Atif Jaleel, MD

• Clinical Social Worker in Urbana, IL
• Providers in Urbana, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2021; 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.

Verify at the official NPI Registry.