Jennifer J Borchardt, LCSW CSAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

8230-123 Issued in WI

Practice address

2611 12TH Street South
Wisconsin Rapids, WI 54494

Phone

(715) 421-8865

NPI assigned

Aug 30, 2012

Last updated

May 10, 2021By the provider in NPPES

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

Other names 1

• Jennifer Derousseau Former name

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

Specialty

Clinical Social Worker

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Cornerstone Clinic LLCGroup PAC ID 0042645046, 11 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.

• Cornerstone Clinic LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Plover, WI
  • NPI 1861037293

  Clinical

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1346284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620604800000",
    "number": "1245589787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 W JACKSON ST",
            "city": "WISCONSIN RAPIDS",
            "state": "WI",
            "postal_code": "544952702",
            "telephone_number": "715-421-8865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2611 12TH STREET SOUTH",
            "city": "WISCONSIN RAPIDS",
            "state": "WI",
            "postal_code": "54494",
            "telephone_number": "715-421-8865"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2558 Post Rd",
            "address_purpose": "LOCATION",
            "city": "Plover",
            "state": "WI",
            "postal_code": "544673331",
            "country_code": "US",
            "telephone_number": "279-871-5600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BORCHARDT",
        "first_name": "JENNIFER",
        "middle_name": "J",
        "credential": "LCSW CSAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-30",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "16080-132",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "8230-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "DEROUSSEAU",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Blessings Holistic Spa LLC
• Bradley S Boettcher, MD
• Sheena Christine Bohl, LPC
• Kathy M Bohman, OTR
• Amanda Jo Bohn, D.C.
• Danelle Ann Bostwick, SLP
• Philip Michael Bovet, DO, MPH
• Pamela K Brayton, MS,CCC-SLP
• Jackie Bredl-Dietrich, PCC
• Amy Elizabeth Brehm, LMFT

• Clinical Social Worker in Wisconsin Rapids, WI
• Providers in Wisconsin Rapids, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2021; 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.