Jacqueline Anna Lydston

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SC61345238 Issued in WA

Practice address

400 E Evergreen Blvd Ste 213
Vancouver, WA 98660-3264

Phone

(360) 977-9679

NPI assigned

Sep 12, 2022

Last updated

Sep 12, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

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": "1662940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1346962974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E EVERGREEN BLVD STE 213",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986603264",
            "telephone_number": "360-977-9679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E EVERGREEN BLVD STE 213",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986603264",
            "telephone_number": "360-977-9679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYDSTON",
        "first_name": "JACQUELINE",
        "middle_name": "ANNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-12",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "SC61345238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Ly
• Lydia Kay Lyall, RDA
• Yelena Lyashchina
• Shellie Marie Lyden, PT
• Jenny Barbo Lydick, RN
• Brynn Taylor Lydum, MS CF-SLP
• Courtney Marie Lyell
• Stephanie Lyle, LICSW, LCSW
• Sarah Lynch Dewitt, LCSW
• Colette Lynch-Sajo

• Clinical Social Worker in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; 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.