Jacob Michael Lisak

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801108553 Issued in MI

Practice address

200 N Madison St
Marshall, MI 49068-1199

Phone

(269) 789-3862

Fax

(269) 789-8126

NPI assigned

Jun 10, 2026

Sex

Male

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

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1781049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781049600000",
    "number": "1770417263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 S CAPITAL AVE",
            "city": "ATHENS",
            "state": "MI",
            "postal_code": "490119335",
            "telephone_number": "269-789-3862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N MADISON ST",
            "city": "MARSHALL",
            "state": "MI",
            "postal_code": "490681199",
            "telephone_number": "269-789-3862",
            "fax_number": "269-789-8126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISAK",
        "first_name": "JACOB",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2026-06-10",
        "last_updated": "2026-06-10",
        "certification_date": "2026-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34009044A",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801108553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olivia Leson
• Heather Levitz
• Annissa Lewis, LPC
• Kelsie Lichtenberger, PA-C
• Meredith Line, LMSW
• Edward Liscombe, PA-C
• Beth Anne List, LLP LPC
• Lo Optical, LLC
• Kristen Elizabeth Logan, PTA
• Jamie Lynn Longhurst, DO

• All providers in Marshall, MI
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2026; 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.