Jackalynn Lee Wilson

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

PC011549 Issued in PA

Practice address

118 Amity Ave
Old Forge, PA 18518-1019

Phone

(570) 905-0669

NPI assigned

Jul 14, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Hidden Grove Art Therapy LLC

  • Professional Counselor
  • Old Forge, PA
  • NPI 1700739935
  NPD Authorized official

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

{
    "created_epoch": "1563062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771286400000",
    "number": "1659923209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 AMITY AVE",
            "city": "OLD FORGE",
            "state": "PA",
            "postal_code": "185181019",
            "telephone_number": "570-905-0669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 AMITY AVE",
            "city": "OLD FORGE",
            "state": "PA",
            "postal_code": "185181019",
            "telephone_number": "570-905-0669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JACKALYNN",
        "middle_name": "LEE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-14",
        "last_updated": "2026-02-17",
        "certification_date": "2026-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "PC011549",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridget Elizabeth Thomas, PHARM D
• Gabrielle Verespey
• Teresa Ann Vieira
• Lori Marie Walton, DPT, PHD, MSCPT
• Julie Washko, CRNP
• Lynn Ann Winter, P.T.
• Lauren E Yanniello, M.S., CCC-SLP
• Anthony Zambetti, D.C.

• Professional Counselor in Old Forge, PA
• Providers in Old Forge, PA by specialty
• Professional Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2026; 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.