Jordan Menefee Chevako, MA

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

8358-125 Issued in WI

Practice address

2600 N Mayfair Rd Ste 650
Wauwatosa, WI 53226-1322

Phone

(414) 771-9304

NPI assigned

Oct 26, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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.

• Shore Counseling and Consulting Clinic, S.C.

  • Group Psychotherapy Psychologist
  • Milwaukee, WI
  • NPI 1588710073
  Medicare reassignment NPD

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

{
    "created_epoch": "1540512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645574400000",
    "number": "1154898252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 N MAYFAIR RD STE 650",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532261322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 N MAYFAIR RD STE 650",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532261322",
            "telephone_number": "414-771-9304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHEVAKO",
        "first_name": "JORDAN",
        "middle_name": "MENEFEE",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-26",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WI",
            "license": "4127-226",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "8358-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100188492",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Meinuo Chen Baca
• Laurel Chen
• Wayne Chen, PSY.D.
• John Cheng, PT
• Heather Chernetski, LPC-IT
• Jennifer Chigonim Chiji-Aguma
• Children'S Hospital of Wisconsin
• Children'S Medical Group
• Childrens Hospital of Wisconsin
• Childynamics LLC

• Professional Counselor in Wauwatosa, WI
• Providers in Wauwatosa, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.