Jill Janae Wickersham, MS IN MARRIAGE AND F

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

44905 Issued in CA

Practice address

1600 W Campbell Ave Ste 201
Campbell, CA 95008-1526

Phone

(408) 871-4908

Fax

(408) 871-4903

NPI assigned

Mar 5, 2007

Last updated

Nov 30, 2019By 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

Other names 1

• Ms. Jill Janae McCann Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 31, 2024 through Jan 31, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575072000000",
    "number": "1477682235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1885 LUNDY AVENUE",
            "address_2": "SUITE 223",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95131",
            "telephone_number": "408-284-9000",
            "fax_number": "408-284-9048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W CAMPBELL AVE STE 201",
            "city": "CAMPBELL",
            "state": "CA",
            "postal_code": "950081526",
            "telephone_number": "408-871-4908",
            "fax_number": "408-871-4903"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "290 Ioof Ave",
            "address_purpose": "LOCATION",
            "city": "Gilroy",
            "state": "CA",
            "postal_code": "950205204",
            "country_code": "US",
            "telephone_number": "408-846-2100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WICKERSHAM",
        "first_name": "JILL",
        "middle_name": "JANAE",
        "name_prefix": "Mrs.",
        "credential": "MS IN MARRIAGE AND F",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-05",
        "last_updated": "2019-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "44905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "_~:/?#[]@!$&'()*+,;=%",
            "affiliation": "N",
            "address_1": "1600 W Campbell Ave Ste 201",
            "city": "Campbell",
            "state": "CA",
            "country_code": "US",
            "postal_code": "950081526",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JILL",
            "last_name": "MCCANN",
            "middle_name": "JANAE",
            "prefix": "MS.",
            "credential": "MS IN MARRIAGE AND F",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Marriage & Family Therapist in Campbell, CA
• Providers in Campbell, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.