Jennifer Ann Itskovich, MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

20368 Issued in MN

Practice address

700 Commerce Dr Ste 255
Woodbury, MN 55125-5406

Phone

(651) 714-3848

Fax

(651) 344-0820

NPI assigned

May 17, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Acres for Life Therapy & Wellness Center

  • Counselor
  • Chisago City, MN
  • NPI 1053702910
  NPD
• Resiliency and Health Institute, LLC

  • Counseling Psychologist
  • Woodbury, MN
  • NPI 1265856801
  NPD (past)

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664496000000",
    "number": "1427265255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10634 E RIVERSIDE DR STE 130",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980113758",
            "telephone_number": "425-821-5021",
            "fax_number": "425-821-7968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 COMMERCE DR STE 255",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551255406",
            "telephone_number": "651-714-3848",
            "fax_number": "651-344-0820"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18323 July Ave N",
            "address_purpose": "LOCATION",
            "city": "Forest Lake",
            "state": "MN",
            "postal_code": "550259788",
            "country_code": "US",
            "telephone_number": "651-257-4159",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ITSKOVICH",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-17",
        "last_updated": "2022-09-30",
        "certification_date": "2022-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LW00009171",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "20368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Irisarri
• Adrienne M Irmiter, PA-C
• Ryan Lawrence Isaacson, O.D.
• Island Therapeutic Massage
• Linda Kay Iten
• Josefa Nazareth Izaola-Jovel
• Jack M Bert MD PA
• Catherine Jackson
• Heather Jackson, OD
• Latasha Cherelle Jackson

• Clinical Social Worker in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2022; 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.