Lisa Jackson-Wardlaw, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904010532 Issued in VA

Practice address

13503 Lee Jackson Memorial Hwy
Chantilly, VA 20151-3401

Phone

(571) 730-7743

NPI assigned

May 9, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in VA, OR2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: lisajacksonwardlaw@tdh.allscriptsdirect.net

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.

• Mental Health Specialty Group PA

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  OR

  Medicare reassignment NPD
• Loudoun Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Leesburg, VA
  • NPI 1629109806
  Medicare reassignment
• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Clinical

  NPD

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

{
    "created_epoch": "1462752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689897600000",
    "number": "1427404599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13503 LEE JACKSON MEMORIAL HWY",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201513401",
            "telephone_number": "571-970-8093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13503 LEE JACKSON MEMORIAL HWY",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201513401",
            "telephone_number": "571-730-7743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON-WARDLAW",
        "first_name": "LISA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-05-09",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "LA",
            "license": "17963",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L14171",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904010532",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Inova Physician Partners, LLC
• Institute for Dermatopathology, Inc.
• Integrated Healthcare Systems Inc
• Max-Andre Isidore, LCSW
• Dixine D Iverson, COTA
• Catherine Elizabeth Jackson
• Hope Lachiel Jackson
• Ileana Jackson, OT
• Chantal H Jacques, O.D.
• Sydney Mae Jakubik

• Clinical Social Worker in Chantilly, VA
• Providers in Chantilly, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2023; 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.