Stacy Jean Nielsen, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L6376 Issued in OR

Practice address

29398 Recovery Way
Junction City, OR 97448-8447

Phone

(541) 465-2505

NPI assigned

Nov 4, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Stacy Jean Nielsen Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: stacy.nielsen@dhsoha.state.or.us

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.

• Western Clinical & Forensic Services

  • Clinical Psychologist
  • Eugene, OR
  • NPI 1114498854
  NPD (past)

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

{
    "created_epoch": "1257292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1659608115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 EXECUTIVE PKWY STE 260",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974017121",
            "telephone_number": "541-802-6597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29398 RECOVERY WAY",
            "city": "JUNCTION CITY",
            "state": "OR",
            "postal_code": "974488447",
            "telephone_number": "541-465-2505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 Executive Pkwy Ste 260",
            "address_purpose": "LOCATION",
            "city": "Eugene",
            "state": "OR",
            "postal_code": "974017121",
            "country_code": "US",
            "telephone_number": "218-460-0924",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIELSEN",
        "first_name": "STACY",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-04",
        "last_updated": "2023-11-27",
        "certification_date": "2020-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L6376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Stacy.Nielsen@dhsoha.state.or.us",
            "affiliation": "Y",
            "endpointDescription": "State email",
            "affiliationName": "DHS/Office of Financial Services IRS/EOPC/BMRC/EOTC/OSH/OSH-P",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "29398 Recovery Way",
            "city": "Junction City",
            "state": "OR",
            "country_code": "US",
            "postal_code": "974488447",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "NIELSEN",
            "middle_name": "JEAN",
            "credential": "MSW, LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Tamera Lane O'Guinn, RN

• Clinical Social Worker in Junction City, OR
• Providers in Junction City, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.