Jenna Rose Forrest Mangold, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149015289 Issued in IL

Practice address

706 Oglesby Ave
Suite 300
Normal, IL 61761-4616

Phone

(309) 826-5806

NPI assigned

Jun 25, 2009

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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1245888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475452800000",
    "number": "1497983613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3606 COMO CT",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617619678",
            "telephone_number": "309-826-5806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 OGLESBY AVE",
            "address_2": "SUITE 300",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617614616",
            "telephone_number": "309-826-5806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGOLD",
        "first_name": "JENNA",
        "middle_name": "ROSE FORREST",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-25",
        "last_updated": "2016-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149015289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen L Major, L.C.S.W.
• Angela Malinowski
• Tara Malinowski
• Ajay R Malpani, M.D.
• Kimberly A Mancilla, SA-C
• Saravanakumar Manickam, MD
• Kimberlee Marisa Manieri, BCBA
• Shannon Marie Brieashia Marcum
• Diana Lee Mariani, MSW, LCSW
• Karen Ingrid Mark, PHD

• Clinical Social Worker in Normal, IL
• Providers in Normal, 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 Oct 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.