Elizabeth A Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-33837 Issued in ID

Practice address

1111 S Orchard St Ste 100
Boise, ID 83705-1961

Phone

(208) 794-9588

NPI assigned

Feb 18, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ID

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

State licenses

Practice roles

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.

• Utopia Counselling and Adoption Services, PLLC

  • Clinical Social Worker
  • Boise, ID
  • NPI 1578076865
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1392681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709424000000",
    "number": "1649694233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 S ORCHARD ST STE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837051961",
            "telephone_number": "208-794-9588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 S ORCHARD ST STE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837051961",
            "telephone_number": "208-794-9588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ELIZABETH",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-02-18",
        "last_updated": "2024-03-03",
        "certification_date": "2024-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WY",
            "license": "PCSW-535",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ID",
            "license": "LMSW-31478",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-33837",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649694233",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "3387",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelley Marie Jacks, MD
• Ashley Jackson, PHARMD
• Caleb Jackson
• Chad Harman Jackson, MD
• Derek Dean Jackson, MD
• John A Jackson, M.D.
• Keri Lynn Jackson, M.D.
• Leah Jackson, ARNP
• Leah Irene Jackson, LMSW
• Yvette Lisa Jackson, LCSW

• Clinical Social Worker in Boise, ID
• Providers in Boise, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2024; 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.