Individual provider Active NPI

Jaelyn Connaughty

  • Clinical Social Worker
  • Green Bay, WI
National Provider Identifier
1295509982
Registry record updated Apr 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
1499 6TH St
Green Bay, WI 54304-2252
Phone
(920) 497-6161
Fax
(888) 974-5769
NPI assigned
Nov 13, 2023
Last updated
Apr 7, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X WI Primary

Addresses

Primary practice location

1499 6TH St
Green Bay, WI 54304-2252

Mailing address

1499 6TH St
Green Bay, WI 54304-2252
Phone (920) 497-6161

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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

Enrollment IDStateProvider typePAC IDDetails
I20260508002004 WI Practitioner - Clinical Social Worker 5698243566 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1499 6TH St
Green Bay, WI 54304-2252

1959 Scheuring Rd
Apt 3
De Pere, WI 54115-7595

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Innovative Counseling Inc CurrentSince Nov 19, 2023 Accepting new patients

Locations

1499 6th St
Green Bay, WI 54304
Phone (920) 497-6161

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1699833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775520000000",
    "number": "1295509982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1499 6TH ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543042252",
            "telephone_number": "920-497-6161",
            "fax_number": "888-974-5769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1499 6TH ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543042252",
            "telephone_number": "920-497-6161",
            "fax_number": "888-974-5769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNAUGHTY",
        "first_name": "JAELYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-13",
        "last_updated": "2026-04-07",
        "certification_date": "2026-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.