Active NPI
Jessica D Wong, LPC, MA
- Professional Counselor
- Fort Collins, CO
National Provider Identifier
1639545296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC.0013464
- Practice address
- 700 Centre Ave
Fort Collins, CO 80526-2023 - Phone
- (970) 494-4200
- NPI assigned
- Aug 18, 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC.0013464 | CO | Primary |
Addresses
Primary practice location
700 Centre Ave
Fort Collins, CO 80526-2023
Mailing address
4856 Innovation Dr Ste B
Fort Collins, CO 80525-5540
Phone (970) 494-4200
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC.0013464 | CO | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559260800000",
"number": "1639545296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4856 INNOVATION DR STE B",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805255540",
"telephone_number": "970-494-4200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 CENTRE AVE",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805262023",
"telephone_number": "970-494-4200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "JESSICA",
"middle_name": "D",
"credential": "LPC, MA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-18",
"last_updated": "2019-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CO",
"license": "LPC.0013464",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.