Jalisa Smith-Jordan, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149024181 Issued in IL

Practice address

1200 Hamilton Blvd
Peoria, IL 61606-1525

Phone

(309) 671-8040

NPI assigned

Apr 27, 2022

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

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.

• Tazwood Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Pekin, IL
  • NPI 1083671127

  Clinical

  NPD

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

{
    "created_epoch": "1651017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651017600000",
    "number": "1659015451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 HAMILTON BLVD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616061525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 HAMILTON BLVD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616061525",
            "telephone_number": "309-671-8040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH-JORDAN",
        "first_name": "JALISA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-27",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149024181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "149024181",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "149024181",
            "affiliation": "N",
            "endpointDescription": "license",
            "address_1": "1200 Hamilton Blvd",
            "city": "Peoria",
            "state": "IL",
            "country_code": "US",
            "postal_code": "616061525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Anna Carney Smarjesse
• Stephen J Smart, MD
• Lindsay Smick, CRNA
• Elizabeth S. Smid Garcia, PA
• Smith Surgical Supply Inc
• Asia Smith-Vernon, RDH
• Alexander Blake Smith
• Andrea Smith, RBT
• Bonnie Smith, M.D.
• Brooke Miranda Smith

• Clinical Social Worker in Peoria, IL
• Providers in Peoria, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2022; 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.