Jacqueline Jendrisak

Primary specialty

CounselorTaxonomy code 101Y00000X

License

LAC-20296 Issued in AZ

Practice address

600 E Gurley St
Prescott, AZ 86301-3246

Phone

(000) 000-0000

NPI assigned

Apr 8, 2024

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1712534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777420800000",
    "number": "1245083708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 E GURLEY ST STE A",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863013246",
            "telephone_number": "602-541-2044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 E GURLEY ST",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863013246",
            "telephone_number": "000-000-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENDRISAK",
        "first_name": "JACQUELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-08",
        "last_updated": "2026-04-29",
        "certification_date": "2026-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "AZ",
            "license": "LAC-20296",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason C. Campbell DDS.
• Francisco Jaume, D.O.
• Derek Jeanes
• Jeff Henderson PHD Psychological Services and Consulting PC
• Renee A Jelinek, M.D.
• Roger Cain Jenkins Jr., MD
• Karen E Jensen, LCSW, CCM
• Richard C. Jirsa, DDS
• John F Mackenzie DO PC
• John P Passamani MD PA

• Counselor in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.