Active NPI
Jane Burgess Wallen, LCSW
- Clinical Social Worker
- Louisa, KY
National Provider Identifier
1245258383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- KY-1263
- Practice address
- 60 Professional Park Dr
Louisa, KY 41230-9644 - Phone
- (606) 638-4332
- Fax
- (606) 638-4394
- NPI assigned
- Jul 17, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | KY-1263 | KY | Primary |
Addresses
Primary practice location
60 Professional Park Dr
Louisa, KY 41230-9644
Mailing address
PO Box 790
Ashland, KY 41105-0790
Phone (606) 329-8588
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001723358 | Other | MSBCBS | |
| 7100282900 | Medicaid | KY | |
| 610661987 | Other | CORPHEALTH | |
| 1175490 | Other | CHA | |
| 000000207306 | Other | KY | ANTHEM BCBS |
| 11491126 | Other | CAQH # | |
| 279403 | Other | MANAGED HEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| KY-1263 | KY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415318400000",
"number": "1245258383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 790",
"city": "ASHLAND",
"state": "KY",
"postal_code": "411050790",
"telephone_number": "606-329-8588",
"fax_number": "606-329-8195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60 PROFESSIONAL PARK DR",
"city": "LOUISA",
"state": "KY",
"postal_code": "412309644",
"telephone_number": "606-638-4332",
"fax_number": "606-638-4394"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLEN",
"first_name": "JANE",
"middle_name": "BURGESS",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-17",
"last_updated": "2014-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "KY",
"license": "KY-1263",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MSBCBS",
"identifier": "001723358",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7100282900",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CORPHEALTH",
"identifier": "610661987",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHA",
"identifier": "1175490",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "000000207306",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH #",
"identifier": "11491126",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MANAGED HEALTH",
"identifier": "279403",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Louisa, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.