Jaclyn Nina Geitner, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

8509-123 Issued in WI

Practice address

424 E Longview Dr Ste a
Appleton, WI 54911

Phone

(920) 234-9240

Fax

(920) 335-0014

NPI assigned

Oct 6, 2011

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

Other identifiers 1

Other names 1

• Jaclyn Nina Knutson Former name

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• CCP Clinic, LLC

  • Clinical Psychologist
  • De Pere, WI
  • NPI 1396431714
  Medicare reassignment NPD Authorized official
• Counseling and Consulting Professionals, LLC

  • Clinical Social Worker
  • Appleton, WI
  • NPI 1891391116
  NPD

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

{
    "created_epoch": "1317859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568246400000",
    "number": "1629352844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 E LONGVIEW DR STE A",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549112167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 E LONGVIEW DR STE A",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "54911",
            "telephone_number": "920-234-9240",
            "fax_number": "920-335-0014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEITNER",
        "first_name": "JACLYN",
        "middle_name": "NINA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-06",
        "last_updated": "2019-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "8509-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100033143",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "KNUTSON",
            "middle_name": "NINA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Andrea Michelle Gehrke, PHARM D
• Tara Geier, MA, BCBA
• Luke Geiger, MSW, LCSW, CSAC
• Katie Geiser, NP
• Rosann Geiser, RN
• Gelle Transportation LLC
• Kenneth A Geller, MD
• Kathleen R Gendron, NP
• Genesis Chiropractic LLC
• Genesis Counseling Ministries LLC

• Clinical Social Worker in Appleton, WI
• Providers in Appleton, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.