Individual provider Active NPI

Alejandra Vences-Jurado, LMSW

  • Clinical Social Worker
  • Grand Rapids, MI
National Provider Identifier
1780225565
Registry record updated Apr 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801113887 Issued in MI
Practice address
2172 Dean Lake Ave NE
Grand Rapids, MI 49505-4444
Phone
(616) 690-1433
Fax
(616) 774-3842
NPI assigned
Oct 3, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6801105856 MI
Clinical Social Worker 1041C0700X 6801113887 MI Primary

Addresses

Primary practice location

2172 Dean Lake Ave NE
Grand Rapids, MI 49505-4444

Mailing address

2172 Dean Lake Ave NE
Grand Rapids, MI 49505-4444
Phone (616) 690-1433

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801105856MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
D a Blodgett-St Johns Clinical CurrentSince Apr 1, 2022 Accepting new patients
Intercare Community Health Network Past Accepting new patients

Locations

2172 Dean Lake Ave NE
Grand Rapids, MI 49505
Phone (616) 451-2021

805 Leonard St NE
Grand Rapids, MI 49503
Phone (616) 451-2021

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": "1570060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681948800000",
    "number": "1780225565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2172 DEAN LAKE AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495054444",
            "telephone_number": "616-690-1433",
            "fax_number": "616-774-3842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2172 DEAN LAKE AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495054444",
            "telephone_number": "616-690-1433",
            "fax_number": "616-774-3842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENCES-JURADO",
        "first_name": "ALEJANDRA",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-03",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801105856",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801113887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 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.