Active NPI
Jack Wood, MSSW
- Social Worker
- Brown Deer, WI
National Provider Identifier
1487843736
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 3900 W Brown Deer Rd Ste 200
Brown Deer, WI 53209-1220 - Phone
- (414) 540-2170
- NPI assigned
- Oct 22, 2007
- Last updated
- Oct 22, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | Primary |
Addresses
Primary practice location
3900 W Brown Deer Rd Ste 200
Brown Deer, WI 53209-1220
Mailing address
1390 Greenway Ter Apt 2
Brookfield, WI 53005-6913
Phone (262) 957-4138
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42244700 | Medicaid | WI |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193011200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193011200000",
"number": "1487843736",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1390 GREENWAY TER APT 2",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530056913",
"telephone_number": "262-957-4138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3900 W BROWN DEER RD STE 200",
"city": "BROWN DEER",
"state": "WI",
"postal_code": "532091220",
"telephone_number": "414-540-2170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOOD",
"first_name": "JACK",
"credential": "MSSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-22",
"last_updated": "2007-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "42244700",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brown Deer, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.