Jan Wimmer, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

125403-3501 Issued in UT

Practice address

186 E 1800 N
North Logan, UT 84341-2019

Phone

(435) 770-1429

NPI assigned

Jun 14, 2017

Last updated

Jun 14, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Mar 7, 2024 through Mar 7, 2028

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Camille Webb LLC

  • Clinical Social Worker
  • North Logan, UT
  • NPI 1942164116
  NPD (past)

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

{
    "created_epoch": "1497398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1497398400000",
    "number": "1689104309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 STONEHENGE DR",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329645",
            "telephone_number": "435-770-1429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "186 E 1800 N",
            "city": "NORTH LOGAN",
            "state": "UT",
            "postal_code": "843412019",
            "telephone_number": "435-770-1429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIMMER",
        "first_name": "JAN",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-14",
        "last_updated": "2017-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "UT",
            "license": "125403-6008",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "125403-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel White
• Dennis Wildman, CSW
• Lee Martin Williams Sr., LCSW, SUDC
• Tiera Williams, PTA
• Cody R Wilson, D.O.
• Wood Wound Care, LLC
• Robert P Young, M.D.

• Clinical Social Worker in North Logan, UT
• Providers in North Logan, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2017; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.