Active NPI
Tracy Lynn Jurgens, APSW
- Clinical Social Worker
- Beloit, WI
National Provider Identifier
1265659551
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 1969 W Hart Rd
Beloit, WI 53511-2230 - Phone
- (608) 364-5686
- Fax
- (608) 363-5756
- NPI assigned
- Apr 19, 2007
- 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 | WI | Primary |
Addresses
Primary practice location
1969 W Hart Rd
Beloit, WI 53511-2230
Mailing address
2435 King CV
Belvidere, IL 61008-7453
Phone (815) 544-7707
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 126790-121 | WI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1265659551",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2435 KING CV",
"city": "BELVIDERE",
"state": "IL",
"postal_code": "610087453",
"telephone_number": "815-544-7707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1969 W HART RD",
"city": "BELOIT",
"state": "WI",
"postal_code": "535112230",
"telephone_number": "608-364-5686",
"fax_number": "608-363-5756"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JURGENS",
"first_name": "TRACY",
"middle_name": "LYNN",
"credential": "APSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beloit, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.