Jillyn Kaufman, PLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

JILLYN KAUFMAN, PLC

Doing business as

Blue Tree Counseling & Consultation

Practice address

3475 Jersey Ridge Rd Ste 2
Davenport, IA 52807-2293

Phone

(319) 481-3534

Fax

(563) 213-5615

NPI assigned

Aug 31, 2020

Organization subpart

No

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

Authorized official

Name

Jillyn M Kaufman, LISWNPI 1528225158

Title

Owner/Clinical Therapist

Phone

(319) 481-3534

Specialties & licenses 1

Addresses

Other names 1

• Blue Tree Counseling & Consultation Doing business as

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jillyn M Kaufman, LISW

  • Clinical Social Worker
  • Davenport, IA
  • NPI 1528225158
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1598832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670630400000",
    "number": "1760095582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3475 JERSEY RIDGE RD STE 2",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072293",
            "telephone_number": "319-481-3534",
            "fax_number": "563-213-5615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3475 JERSEY RIDGE RD STE 2",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072293",
            "telephone_number": "319-481-3534",
            "fax_number": "563-213-5615"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3333 18th St",
            "address_purpose": "LOCATION",
            "city": "Bettendorf",
            "state": "IA",
            "postal_code": "527222775",
            "country_code": "US",
            "telephone_number": "319-481-3534",
            "fax_number": "563-213-5615",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JILLYN KAUFMAN, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-31",
        "last_updated": "2022-12-10",
        "certification_date": "2022-12-10",
        "status": "A",
        "authorized_official_last_name": "KAUFMAN",
        "authorized_official_first_name": "JILLYN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/CLINICAL THERAPIST",
        "authorized_official_telephone_number": "319-481-3534",
        "authorized_official_credential": "LISW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Tree Counseling & Consultation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Social Worker in Davenport, IA
• Providers in Davenport, IA by specialty
• Clinical Social Worker in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.