Active NPI
Veronda Jackson
- Case Manager/Care Coordinator
- Milwaukee, WI
National Provider Identifier
1417606559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 3774 N 13TH St
Milwaukee, WI 53206-3011 - Phone
- (414) 792-0775
- NPI assigned
- Mar 23, 2022
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 17739-130 | WI | |
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
3774 N 13TH St
Milwaukee, WI 53206-3011
Mailing address
3774 N 13TH St
Milwaukee, WI 53206-3011
Phone (414) 792-0775
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://mail.google.com/mail/u/0/#inbox | Direct |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17739-130 | WI | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1647993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647993600000",
"number": "1417606559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3774 N 13TH ST",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532063011",
"telephone_number": "414-792-0775"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3774 N 13TH ST",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532063011",
"telephone_number": "414-792-0775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "VERONDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-23",
"last_updated": "2022-03-23",
"certification_date": "2022-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "17739-130",
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://mail.google.com/mail/u/0/#inbox",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "3774 N 13th St",
"city": "Milwaukee",
"state": "WI",
"country_code": "US",
"postal_code": "532063011",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 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.