Jessica Sky Smith, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

20593 Issued in MN

Practice address

103 N Broad St
Mankato, MN 56001-3519

Phone

(507) 345-7012

NPI assigned

Oct 12, 2012

Last updated

Nov 7, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Jessica Sky Niesen Former name

Medicare fee-for-service enrollment

Enrolled in MN

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, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Resilience CenterGroup PAC ID 3870993579, 8 clinicians

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Resilience Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Rochester, MN
  • NPI 1740865146
  Medicare reassignment Care Compare group NPD
• Livewell Counseling Center, LLC

  • Clinical Social Worker
  • Rochester, MN
  • NPI 1316298847
  Authorized official Same address or phone
• Adult, Child & Family Services, LLC

  • Psychologist
  • Mankato, MN
  • NPI 1902806045
  NPD (past)
• Five Rivers Mental Health LLC

  dba Five Rivers Mental Health Clinic LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Mankato, MN
  • NPI 1689111601
  NPD (past)

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

{
    "created_epoch": "1350000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541548800000",
    "number": "1215289376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 N. BROAD ST.",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "56001",
            "telephone_number": "507-951-3874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 N BROAD ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560013519",
            "telephone_number": "507-345-7012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JESSICA",
        "middle_name": "SKY",
        "name_prefix": "Dr.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-12",
        "last_updated": "2018-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "20593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "NIESEN",
            "middle_name": "SKY",
            "prefix": "DR.",
            "credential": "LICSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Anita Linnea Smith, MS, LPC, NCC
• Carolyn Smith
• Charles Smith
• Jenna Smith
• Jessica Lynn Smith, M.A.
• Rebecca Lynne Smith
• Ruth Esther Smith, MD
• Thomas Smyth, D.D.S.
• Kailyn Victoria Snodgrass, BS
• Lillian Carol Snow

• Clinical Social Worker in Mankato, MN
• Providers in Mankato, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2018; 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.