Jessica Peterson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-39938 Issued in ID

Practice address

1044 Northwest Blvd Ste C
Coeur D Alene, ID 83814-2114

Phone

(208) 930-1740

Fax

(208) 930-1695

NPI assigned

Jun 7, 2017

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

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

Specialty

Clinical Social Worker

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ambitions of Idaho IncGroup PAC ID 6305121328, 7 clinicians

Practice addresses (Care Compare)

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.

• Ambitions of Idaho, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Coeur D Alene, ID
  • NPI 1003145533

  Clinical, ID

  Medicare reassignment Care Compare group NPD
• Ambitions of Idaho, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Coeur D Alene, ID
  • NPI 1689133050
  NPD

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

{
    "created_epoch": "1496793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697068800000",
    "number": "1669901260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 NORTHWEST BLVD STE C",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142114",
            "telephone_number": "208-930-1740",
            "fax_number": "208-930-1695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 NORTHWEST BLVD STE C",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142114",
            "telephone_number": "208-930-1740",
            "fax_number": "208-930-1695"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1038 Northwest Blvd",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838142249",
            "country_code": "US",
            "telephone_number": "208-930-1740",
            "fax_number": "208-930-1695",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JESSICA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-07",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-39938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lori Petersen
• Mariah Petersen, APP
• Chad Allan Peterson, M.D.
• Heather Peterson
• Hunter Peterson, N.D.
• Jill Peterson
• Katrina E Peterson, RD
• Makayla Bernadine Peterson
• Jared Petrick
• Brenna J. Petro, FNP

• All providers in Coeur D Alene, ID
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.