Jacqueline A Wondolowski, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6801021654 Issued in MI

Practice address

350 Lafayette Ave SE Ste 301
Grand Rapids, MI 49503-4656

Phone

(616) 458-0801

Fax

(616) 458-4065

NPI assigned

Apr 25, 2019

Last updated

Apr 25, 2019By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rehabilitation and Physical Medicine Specialists PCGroup PAC ID 2264589688, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Rehabilitation & Physical Medicine Specialists, P.C.

  • Physical Medicine & Rehabilitation Physician
  • Grand Rapids, MI
  • NPI 1639256902
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1556150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556150400000",
    "number": "1255995213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 LAFAYETTE AVE SE STE 301",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034656",
            "telephone_number": "616-458-0801",
            "fax_number": "616-458-4065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 LAFAYETTE AVE SE STE 301",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034656",
            "telephone_number": "616-458-0801",
            "fax_number": "616-458-4065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONDOLOWSKI",
        "first_name": "JACQUELINE",
        "middle_name": "A",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-25",
        "last_updated": "2019-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801021654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenna Wolthuis
• Luke Wolthuis
• Margaret Elizabeth Woltjer, PH.D.
• Womens Health Collective
• Kaley J Wondergem, LMSW
• Tina W Wong-Gillam, M.D.-PH.D.
• Amanda Michelle Wong, M.S.
• Brandon Joseph Wong, MD
• Frances Ying-Nok Wong, MD
• Leslie B Wong, MD

• Social Worker in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2019; 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.