Active NPI
Jaclyn A Moglowsky, MA, LPC
- Mental Health Counselor
- Mequon, WI
National Provider Identifier
1699864116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 3498-125
- Practice address
- 1240 W Ranchito LN
Mequon, WI 53092-6090 - Phone
- (262) 241-3231
- Fax
- (262) 241-4311
- NPI assigned
- Oct 12, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 3498-125 | WI | Primary |
Addresses
Primary practice location
1240 W Ranchito LN
Mequon, WI 53092-6090
Mailing address
1240 W Ranchito LN
Mequon, WI 53092-6090
Phone (262) 241-3231
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40957500 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3498-125 | WI | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699864116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1240 W RANCHITO LN",
"city": "MEQUON",
"state": "WI",
"postal_code": "530926090",
"telephone_number": "262-241-3231",
"fax_number": "262-241-4311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1240 W RANCHITO LN",
"city": "MEQUON",
"state": "WI",
"postal_code": "530926090",
"telephone_number": "262-241-3231",
"fax_number": "262-241-4311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOGLOWSKY",
"first_name": "JACLYN",
"middle_name": "A",
"credential": "MA, LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WI",
"license": "3498-125",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40957500",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mequon, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.