Jessica J Siwak, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.015177 Issued in IL

Practice address

920 W Custer Ave
Pontiac, IL 61764-1067

Phone

(815) 844-6109

Fax

(815) 844-3561

NPI assigned

Mar 20, 2012

Last updated

Jun 27, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jessica J Mullen Former name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Institute for Human Resources of Livingston County, Il

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Pontiac, IL
  • NPI 1649239674
  NPD

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

{
    "created_epoch": "1332201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1477828713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 768",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617640768",
            "telephone_number": "815-844-6109",
            "fax_number": "815-844-3561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 W CUSTER AVE",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617641067",
            "telephone_number": "815-844-6109",
            "fax_number": "815-844-3561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIWAK",
        "first_name": "JESSICA",
        "middle_name": "J",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-20",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.015177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "MULLEN",
            "middle_name": "J",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Schivaughn Scully, MSW
• Samantha Shoop, QMHP
• Rajendra Shrivastav, MD
• Melissa Sidler, MHP
• Param Jeet Singh, O.D.
• Rachel Skoumal, APRN
• Sylvia M Smiser, PT
• Kaitlyn Smith, RSA
• John Souder, PT
• Alexis Spangler, MSW

• Clinical Social Worker in Pontiac, IL
• Providers in Pontiac, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; 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.