Jordan Koegle, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I2102753 Issued in OH

Practice address

3964 Hamilton Square Blvd
Groveport, OH 43125-9119

Phone

(614) 610-1506

Fax

(614) 834-8694

NPI assigned

Nov 7, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1573084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623888000000",
    "number": "1265077812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3964 HAMILTON SQUARE BLVD",
            "city": "GROVEPORT",
            "state": "OH",
            "postal_code": "431259119",
            "telephone_number": "614-610-1506",
            "fax_number": "614-834-8694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3964 HAMILTON SQUARE BLVD",
            "city": "GROVEPORT",
            "state": "OH",
            "postal_code": "431259119",
            "telephone_number": "614-610-1506",
            "fax_number": "614-834-8694"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3964 Hamilton Square Blvd",
            "address_purpose": "LOCATION",
            "city": "Groveport",
            "state": "OH",
            "postal_code": "431259119",
            "country_code": "US",
            "telephone_number": "614-362-1686 x1858",
            "fax_number": "614-834-8694",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOEGLE",
        "first_name": "JORDAN",
        "credential": "LISW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-11-07",
        "last_updated": "2021-06-17",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.1600951",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I2102753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• LDS Social Services

• Clinical Social Worker in Groveport, OH
• Providers in Groveport, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2021; 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.