Jaclyn Randolph

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

375 N Main St
Kaysville, UT 84037-1199

Phone

(801) 844-1615

NPI assigned

Oct 19, 2021

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

Enrolled in UT

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fiddle Creek Counseling

  • Clinical Social Worker
  • Kaysville, UT
  • NPI 1649040536
  NPD Authorized official

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

{
    "created_epoch": "1634601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634601600000",
    "number": "1417610189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 N MAIN ST",
            "city": "KAYSVILLE",
            "state": "UT",
            "postal_code": "840371199",
            "telephone_number": "801-844-1615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 N MAIN ST",
            "city": "KAYSVILLE",
            "state": "UT",
            "postal_code": "840371199",
            "telephone_number": "801-844-1615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "JACLYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-19",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Putman
• Lillie Marie Puzey, L.C.S.W.
• Alexius Pyne
• Quassapaug Ventures
• Lori K Ramirez, MD
• Hailey Ransley, CSW
• Brett Michael Rawlins, FNP
• RBD &C Inc
• Francesca Regier
• Restoration Physical Therapy LLC

• Clinical Social Worker in Kaysville, UT
• Providers in Kaysville, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.