Jaclyn Decorsey

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

29463 Issued in MN

Practice address

394 S Lake Ave Ste 515
Duluth, MN 55802-2325

Phone

(218) 206-6676

NPI assigned

Dec 5, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jaclyn Ostman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Northern Edge Counseling, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Duluth, MN
  • NPI 1598523110
  NPD Authorized official
• Accend Services Incorporated

  • Adult Mental Health Clinic/Center
  • Duluth, MN
  • NPI 1417023458
  NPD (past)

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

{
    "created_epoch": "1543968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709856000000",
    "number": "1447720248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "394 S LAKE AVE STE 515",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558022325",
            "telephone_number": "218-206-6676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "394 S LAKE AVE STE 515",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558022325",
            "telephone_number": "218-206-6676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECORSEY",
        "first_name": "JACLYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-05",
        "last_updated": "2024-03-08",
        "certification_date": "2024-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "29463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "OSTMAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Wade William Deaustin, MD
• Keairo Debeltz
• Aleah Tian Deboer
• Rachel Leigh Debruyne, APRN
• Aubrey Decker
• Nicholas Scott Dee, MD
• James Deegan
• Deeper Bond, PLLC
• Joni Christine Deetz, MSW, LICSW
• Alyssa Ann Defoe, LGSW

• Clinical Social Worker in Duluth, MN
• Providers in Duluth, 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 Mar 8, 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.

Verify at the official NPI Registry.