Active NPI
Marissa Jepsen, LCSW
- Clinical Social Worker
- Wheaton, IL
National Provider Identifier
1659021996
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 107341
- Practice address
- 1512 Daly Rd
Wheaton, IL 60187-3310 - Phone
- (310) 993-5230
- NPI assigned
- Mar 28, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 107341 | CA | Primary |
Addresses
Primary practice location
1512 Daly Rd
Wheaton, IL 60187-3310
Mailing address
40W927 Il Route 64
St Charles, IL 60175-5314
Phone (310) 993-5230
Medicare participation
Medicare enrollment files- 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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107341 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695254400000",
"number": "1659021996",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40W927 IL ROUTE 64",
"city": "ST CHARLES",
"state": "IL",
"postal_code": "601755314",
"telephone_number": "310-993-5230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1512 DALY RD",
"city": "WHEATON",
"state": "IL",
"postal_code": "601873310",
"telephone_number": "310-993-5230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEPSEN",
"first_name": "MARISSA",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-03-28",
"last_updated": "2023-09-21",
"certification_date": "2023-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "107341",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wheaton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; 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.