Individual provider Active NPI

Ashley Virginia Ann Jakel, MSW, LCSW, SAC-IT

  • Clinical Social Worker
  • Black River Falls, WI
National Provider Identifier
1194272419
Registry record updated Feb 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
9110 Issued in WI
Practice address
N6520 Lumberjack Guy Rd
Black River Falls, WI 54615-5405
Phone
(715) 284-9851
Fax
(715) 284-3434
NPI assigned
Sep 2, 2016
Last updated
Feb 1, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 9110 WI Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X 18634 WI

Addresses

Primary practice location

N6520 Lumberjack Guy Rd
Black River Falls, WI 54615-5405

Mailing address

N6520 Lumberjack Guy Rd
Black River Falls, WI 54615-5405
Phone (715) 284-9851

Other identifiers 1

IdentifierTypeStateIssuer
100060771MedicaidWI

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20170222001368 WI Practitioner - Clinical Social Worker 3971887761 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18634WIMDAddiction (Substance Use Disorder) Counselor
9110WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Ho-Chunk Nation CurrentSince Jan 21, 2017 Accepting new patients

Locations

N6520 Lumberjack Guy Rd
Blk River Fls, WI 54615
Phone (715) 284-9851

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1472774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643673600000",
    "number": "1194272419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N6520 LUMBERJACK GUY RD",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546155405",
            "telephone_number": "715-284-9851",
            "fax_number": "715-284-5150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N6520 LUMBERJACK GUY RD",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546155405",
            "telephone_number": "715-284-9851",
            "fax_number": "715-284-3434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAKEL",
        "first_name": "ASHLEY",
        "middle_name": "VIRGINIA ANN",
        "name_prefix": "Mrs.",
        "credential": "MSW, LCSW, SAC-IT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-02",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9110",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "18634",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100060771",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Black River Falls, WI

Sources for this page

Verify at the official NPI Registry.