Active NPI
Jourdan Spencer Cruz, LICSW
- Clinical Social Worker
- Seattle, WA
National Provider Identifier
1457998395
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LW60979431
- Practice address
- 904 7TH Ave
Seattle, WA 98104-1132 - Phone
- (206) 860-4588
- NPI assigned
- Dec 10, 2019
- Last updated
- Dec 10, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 | LW60979431 | WA | Primary |
Addresses
Primary practice location
904 7TH Ave
Seattle, WA 98104-1132
Mailing address
1451 NE Park Dr
Issaquah, WA 98029-8909
Phone (425) 890-9259
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 |
|---|---|---|---|
| LW60979431 | WA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1575936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575936000000",
"number": "1457998395",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1451 NE PARK DR",
"city": "ISSAQUAH",
"state": "WA",
"postal_code": "980298909",
"telephone_number": "425-890-9259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "904 7TH AVE",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981041132",
"telephone_number": "206-860-4588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRUZ",
"first_name": "JOURDAN",
"middle_name": "SPENCER",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-12-10",
"last_updated": "2019-12-10",
"certification_date": "2019-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WA",
"license": "LW60979431",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.