Active NPI
Lucy Jackson, M.S.W.
- Mental Health Counselor
- Madison, WI
National Provider Identifier
1548654353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 127496-121
- Practice address
- 1320 Mendota St Ste 120
Madison, WI 53714-1060 - Phone
- (608) 280-2700
- NPI assigned
- Mar 19, 2015
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 127496-121 | WI | Primary |
Addresses
Primary practice location
1320 Mendota St Ste 120
Madison, WI 53714-1060
Mailing address
25 Kessel CT Ste 105
Madison, WI 53711-6227
Phone (608) 280-2700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100052220 | 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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 127496-121 | WI | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1426723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473206400000",
"number": "1548654353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 KESSEL CT STE 105",
"city": "MADISON",
"state": "WI",
"postal_code": "537116227",
"telephone_number": "608-280-2700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1320 MENDOTA ST STE 120",
"city": "MADISON",
"state": "WI",
"postal_code": "537141060",
"telephone_number": "608-280-2700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "LUCY",
"credential": "M.S.W.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-03-19",
"last_updated": "2016-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WI",
"license": "127496-121",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100052220",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 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.