Active NPI
Jaclyn Conrad, M.S., NCC
- Professional Counselor
- Malvern, PA
National Provider Identifier
1487249702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- PC015505
- Practice address
- 19 N Bacton Hill Rd
Malvern, PA 19355-1005 - Phone
- (412) 532-1249
- NPI assigned
- Mar 8, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Professional Counselor | 101YP2500X | PC015505 | PA | Primary |
Addresses
Primary practice location
19 N Bacton Hill Rd
Malvern, PA 19355-1005
Mailing address
239 4TH Ave FL 18
Pittsburgh, PA 15222-1706
Phone (412) 532-1249
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PC015505 | PA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1615161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694995200000",
"number": "1487249702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "239 4TH AVE FL 18",
"city": "PITTSBURGH",
"state": "PA",
"postal_code": "152221706",
"telephone_number": "412-532-1249"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 N BACTON HILL RD",
"city": "MALVERN",
"state": "PA",
"postal_code": "193551005",
"telephone_number": "412-532-1249"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONRAD",
"first_name": "JACLYN",
"name_prefix": "Miss",
"credential": "M.S., NCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-08",
"last_updated": "2023-09-18",
"certification_date": "2023-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "PA",
"license": "PC015505",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Malvern, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.