Jacqueline Maureen Wilson

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CLINICAL INTERN

Practice address

221 Avenue B
Snohomish, WA 98290-2840

Phone

(425) 349-7244

NPI assigned

Sep 15, 2016

Last updated

Sep 15, 2016By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 2, 2024 through Jul 2, 2028

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Compass Health

  • Community/Behavioral Health Agency
  • Everett, WA
  • NPI 1730136201
  NPD (past)

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

{
    "created_epoch": "1473897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473897600000",
    "number": "1487102687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4526 FEDERAL AVE",
            "address_2": "P.O. BOX 3810",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982032132",
            "telephone_number": "425-349-6200",
            "fax_number": "425-349-7256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 AVENUE B",
            "city": "SNOHOMISH",
            "state": "WA",
            "postal_code": "982902840",
            "telephone_number": "425-349-7244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JACQUELINE",
        "middle_name": "MAUREEN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-15",
        "last_updated": "2016-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": "CLINICAL INTERN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marlo Marie White, PHARMACY TECHNICIAN
• Natalie White, AUD
• Scott Eric White, RPH
• Amanda Wilber
• Marce Alene Williams, PHYSICAL THERAPIST A
• Kim Marie Wilson, RN
• Lorina Aline Wilson, PTA
• Pamela Elizabeth Wireman, PA-C
• Women and Family Wellness Studio
• Jane Y Wong, PHARM D

• Mental Health Counselor in Snohomish, WA
• Providers in Snohomish, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2016; 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.