Jessica N Roosevelt, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

426 W Commerce St
Grayville, IL 62844-1570

Phone

(618) 384-7544

NPI assigned

Jun 2, 2021

Last updated

Jun 2, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rising Strong Counseling LLC

  • Clinical Social Worker
  • Evansville, IN
  • NPI 1952079402
  NPD (past) Authorized official

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

{
    "created_epoch": "1622592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622592000000",
    "number": "1467028241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "426 W COMMERCE ST",
            "city": "GRAYVILLE",
            "state": "IL",
            "postal_code": "628441570",
            "telephone_number": "618-384-7544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "426 W COMMERCE ST",
            "city": "GRAYVILLE",
            "state": "IL",
            "postal_code": "628441570",
            "telephone_number": "618-384-7544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROOSEVELT",
        "first_name": "JESSICA",
        "middle_name": "N",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-02",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meadow Brook Skilled Nursing and Rehab LLC
• Meadow Brook Skilled Nursing and Rehab LLC
• Meadow Brook Skilled Nursing and Rehab LLC
• Miller Family Chiropractic, LLC
• Abby Jo Moore, CD
• Evelyn Marie Salhani, PA-C
• The Haven on the River, LLC
• Andrea Vieck, PA-C
• Ketan C Vyas, MD
• Wabash General Hospital District (Grayville Medical Clinic)

• Mental Health Counselor in Grayville, IL
• Providers in Grayville, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2021; 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.