Active NPI
Jennifer Monjack, LCSW
- Clinical Social Worker
- Fort Worth, TX
National Provider Identifier
1427636455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 103912
- Practice address
- 6777 Camp Bowie Blvd Ste 229
Fort Worth, TX 76116-7157 - Phone
- (682) 703-1311
- Fax
- (817) 887-1694
- NPI assigned
- Mar 31, 2021
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 103912 | TX | Primary |
Addresses
Primary practice location
6777 Camp Bowie Blvd Ste 229
Fort Worth, TX 76116-7157
Mailing address
3840 Hulen St
Fort Worth, TX 76107-7277
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 |
|---|---|---|---|
| 103912 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709251200000",
"number": "1427636455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3840 HULEN ST",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761077277"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6777 CAMP BOWIE BLVD STE 229",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761167157",
"telephone_number": "682-703-1311",
"fax_number": "817-887-1694"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONJACK",
"first_name": "JENNIFER",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-31",
"last_updated": "2024-03-01",
"certification_date": "2024-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "103912",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.