Individual provider Active NPI

Jessica Knoblauch

  • Professional Counselor
  • Columbus, OH
National Provider Identifier
1154696045
Registry record updated Feb 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
E0900020 Issued in OH
Practice address
399 E Main St
Columbus, OH 43215-5384
Phone
(614) 355-8550
Fax
(614) 355-8593
NPI assigned
Mar 12, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X C.0900020 OH
Professional Counselor 101YP2500X E0900020 OH Primary

Addresses

Primary practice location

399 E Main St
Columbus, OH 43215-5384

Mailing address

PO Box 78000
Dept. 781625
Detroit, MI 48278-1625
Phone (614) 355-8004

Other identifiers 1

IdentifierTypeStateIssuer
08258MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C.0900020OHMDMental Health Counselor
E0900020OHMDProfessional Counselor

NPI Registry JSON

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

{
    "created_epoch": "1331510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423094400000",
    "number": "1154696045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 78000",
            "address_2": "DEPT. 781625",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781625",
            "telephone_number": "614-355-8004",
            "fax_number": "614-355-0509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "399 E MAIN ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432155384",
            "telephone_number": "614-355-8550",
            "fax_number": "614-355-8593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNOBLAUCH",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-12",
        "last_updated": "2015-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "C.0900020",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E0900020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08258",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.