Jordan Wayne Schaefer, MSW

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

502 S Morris Ave
Bloomington, IL 61701-4884

Phone

(815) 916-5451

NPI assigned

Jul 10, 2020

Sex

Male

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

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• True Image Counseling PLLC

  • Mental Health Counselor
  • Bloomington, IL
  • NPI 1336093715
  NPD Authorized official

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

{
    "created_epoch": "1594339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594339200000",
    "number": "1467070037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 W LINCOLN ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617016642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 S MORRIS AVE",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617014884",
            "telephone_number": "815-916-5451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHAEFER",
        "first_name": "JORDAN",
        "middle_name": "WAYNE",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-10",
        "last_updated": "2020-07-10",
        "certification_date": "2020-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bea Sawyer, LPC
• Darren M Sawyer, APN
• Sanjay Saxena, M.D.
• Elizabeth Jane Scanlon, NP
• James David Schaefer, MS,ATC
• Melanie Schall
• Jason M Scheid, PHARMD
• Steven K Schimelpfenig, DC
• Kathleen T Schlais
• Carri L Schmitt, PT

• Counselor in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2020; 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.