Jeffrey Wallenberg, CNP-PMHNP

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

G159566 Issued in IA

Practice address

800 5TH St
Sioux City, IA 51101-1317

Phone

(800) 472-9018

NPI assigned

Jul 9, 2020

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

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.

• Thrive Wellness LLC

  • Mental Health Counselor
  • Sioux Falls, SD
  • NPI 1548051295
  NPD Authorized official
• Jackson Recovery Centers, Inc.

  dba Child and Adolescent Recovery Hospital Crisis and Stabilization Unit

  • Children's Substance Abuse Rehabilitation Facility
  • Sioux City, IA
  • NPI 1770966491
  NPD (past)

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

{
    "created_epoch": "1594252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1457979155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 W 49TH ST STE 206",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571064219",
            "telephone_number": "605-271-6582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 5TH ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511011317",
            "telephone_number": "800-472-9018"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3701 W 49th St Ste 206",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571064219",
            "country_code": "US",
            "telephone_number": "605-271-6582",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLENBERG",
        "first_name": "JEFFREY",
        "credential": "CNP-PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-09",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IA",
            "license": "G159566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassidy Walker, FNP-C
• Jaclyn Walker
• Rebecca Walker, RN, BSN, FNP
• Stephanie M. Walker, PA-C
• Sarah Wallace, BSN, RN
• Walmart Inc. (Walmart Pharmacy 10-3590)
• Walmart Inc. (Walmart Pharmacy 10-1361)
• Laurel Walsh, MSW
• Shawn Robert Walton
• Kristi D Walz, MD

• Psychiatry Physician in Sioux City, IA
• Providers in Sioux City, IA by specialty
• Psychiatry Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; 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.