Active NPI
Jennifer Vandivort
- Clinical Social Worker
- Springfield, MO
National Provider Identifier
1255092847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 20150263379
- Practice address
- 4647 E Hidden Oak PL
Springfield, MO 65802-7529 - Phone
- (573) 356-8015
- NPI assigned
- Jan 5, 2022
- 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 | 20150263379 | MO | Primary |
Addresses
Primary practice location
4647 E Hidden Oak PL
Springfield, MO 65802-7529
Mailing address
4647 E Hidden Oak PL
Springfield, MO 65802-7529
Phone (573) 356-8015
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Talkspace | Direct | |
| Other URL | Laptop | Direct | Talkspace |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20150263379 | MO | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641340800000",
"number": "1255092847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4647 E HIDDEN OAK PL",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658027529",
"telephone_number": "573-356-8015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4647 E HIDDEN OAK PL",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658027529",
"telephone_number": "573-356-8015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDIVORT",
"first_name": "JENNIFER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-05",
"last_updated": "2022-01-05",
"certification_date": "2021-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MO",
"license": "20150263379",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Talkspace",
"affiliation": "N",
"endpointDescription": "Online therapy platform",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Talkspace",
"address_1": "4647 E Hidden Oak Pl",
"city": "Springfield",
"state": "MO",
"country_code": "US",
"postal_code": "658027529",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Laptop",
"affiliation": "Y",
"endpointDescription": "Personal laptop",
"affiliationName": "Talkspace",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Mental health",
"address_1": "4647 E Hidden Oak Pl",
"city": "Springfield",
"state": "MO",
"country_code": "US",
"postal_code": "658027529",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Springfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.