Shannon Kris Jacobson, MSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

ASW85634 Issued in CA

Practice address

3200 Motor Ave
Los Angeles, CA 90034

Phone

(310) 836-1223

NPI assigned

Sep 2, 2018

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 AZ

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

Telehealth

Offers telehealth services

Group practices

Selah Counseling Center LLCGroup PAC ID 6507264348, 3 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 and National Provider Directory roles.

• Selah Counseling Center LLC

  • Clinical Social Worker
  • Phoenix, AZ
  • NPI 1518633650
  Medicare reassignment Care Compare group NPD
• Integrative Psychotherapy and Assessment Services

  • Psychologist
  • Phoenix, AZ
  • NPI 1699146910
  Medicare reassignment NPD
• Imagine Change Counseling and Psychotherapy, PLLC

  • Clinical Social Worker
  • Phoenix, AZ
  • NPI 1649945023
  NPD Authorized official

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

{
    "created_epoch": "1535846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537315200000",
    "number": "1225510688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 MOTOR AVENUE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 MOTOR AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90034",
            "telephone_number": "310-836-1223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "SHANNON",
        "middle_name": "KRIS",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-02",
        "last_updated": "2018-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "ASW85634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen R Jacobson
• Lia Jacobson
• Miriam Jacobson, RD
• Pamela Jacobson
• Sarah Jacobson, MA, CCC-SLP
• Sharon Diane Jacobson, MD
• Steven J. Jacobson, MD
• Bradley Alan Jacoby, D.O
• Carrie Jacoby, MFTI
• Karine Jacome Suazo

• Social Worker in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 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.