Jill Michelle Walck, BA

Primary specialty

Social WorkerTaxonomy code 104100000X

Practice address

500 7TH Ave S
St Petersburg, FL 33701-4820

Phone

(727) 767-4403

Fax

(727) 767-4715

NPI assigned

Feb 13, 2007

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1619019106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "945 28TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337136737",
            "telephone_number": "727-368-6271",
            "fax_number": "727-368-6271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 7TH AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014820",
            "telephone_number": "727-767-4403",
            "fax_number": "727-767-4715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALCK",
        "first_name": "JILL",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "BA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-13",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "766932100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Social Worker in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.

Verify at the official NPI Registry.