Individual provider Active NPI

Jennifer Michelle Nowak, LCSW

  • Social Worker
  • Janesville, WI
National Provider Identifier
1720689680
Registry record updated Feb 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
11137 Issued in WI
Practice address
17 S River St Ste 254
Janesville, WI 53548-3863
Phone
(608) 755-5260
NPI assigned
Nov 5, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 11137 WI Primary

Addresses

Primary practice location

17 S River St Ste 254
Janesville, WI 53548-3863

Mailing address

17 S River St Ste 254
Janesville, WI 53548-3863
Phone (608) 755-5260

Other practice location 1

722 Lois Dr
Sun Prairie, WI 53590-1100
Phone (608) 837-9112

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

Practice roles

OrganizationSpecialtyStatusNew patients
Trivium LLC CurrentSince Nov 8, 2020 Accepting new patients
Trivium LLC PastSince Nov 8, 2020 Accepting new patients

Locations

17 S River St
Ste 254
Janesville, WI 53548
Phone (608) 755-5260

722 Lois Dr
Sun Prairie, WI 53590
Phone (608) 755-5260

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1604534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676246400000",
    "number": "1720689680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 S RIVER ST STE 254",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535483863",
            "telephone_number": "608-755-5260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 S RIVER ST STE 254",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535483863",
            "telephone_number": "608-755-5260"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "722 Lois Dr",
            "address_purpose": "LOCATION",
            "city": "Sun Prairie",
            "state": "WI",
            "postal_code": "535901100",
            "country_code": "US",
            "telephone_number": "608-837-9112",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NOWAK",
        "first_name": "JENNIFER",
        "middle_name": "MICHELLE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-05",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "11137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Janesville, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.