Brooke Earin Sjostrom, MS

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LCPC-4347 Issued in ID

Practice address

250 Northwest Blvd Ste 101a
Coeur D Alene, ID 83814-2971

Phone

(208) 691-1174

Fax

(208) 247-8513

NPI assigned

Oct 17, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Jennifer Brooke Sjostrom Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Jennifer Brooke Sjostrom

  • Mental Health Counselor
  • Spokane, WA
  • NPI 1730534272
  NPD (past)

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

{
    "created_epoch": "1539734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539734400000",
    "number": "1255807210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 129",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190129",
            "telephone_number": "208-691-1174",
            "fax_number": "208-247-8513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 NORTHWEST BLVD STE 101A",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142971",
            "telephone_number": "208-691-1174",
            "fax_number": "208-247-8513"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4407 N Division St Ste 603",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992071660",
            "country_code": "US",
            "telephone_number": "208-691-1174",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SJOSTROM",
        "first_name": "BROOKE",
        "middle_name": "EARIN",
        "name_prefix": "Ms.",
        "credential": "MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-17",
        "last_updated": "2018-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LH00007832",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ID",
            "license": "LCPC-4347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "SJOSTROM",
            "middle_name": "BROOKE",
            "credential": "MS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Mental Health Counselor in Coeur D Alene, ID
• Providers in Coeur D Alene, ID by specialty
• Mental Health Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2018; 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.