Jayme Evelyn Bradshaw, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149014853 Issued in IL

Practice address

735 S Locust St
Pontiac, IL 61764-2632

Phone

(815) 690-7170

NPI assigned

Jun 25, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1656115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656115200000",
    "number": "1780316166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 S LOCUST ST",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617642632",
            "telephone_number": "815-690-7170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 S LOCUST ST",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617642632",
            "telephone_number": "815-690-7170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADSHAW",
        "first_name": "JAYME",
        "middle_name": "EVELYN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-25",
        "last_updated": "2022-06-25",
        "certification_date": "2022-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149014853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "bradshawjayme@gmail.com",
            "affiliation": "N",
            "endpointDescription": "private computer",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "private desktop",
            "address_1": "735 S Locust St",
            "city": "Pontiac",
            "state": "IL",
            "country_code": "US",
            "postal_code": "617642632",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Samantha J Binkley, MHP
• Lauren Black, BS
• Emille Blaetz, RSA
• Sandra Boeckmann, LSW
• Sherri M Bowald, APN
• Amillia Jo Brady
• Diana Brandt
• Sherry Brendalen, LPC
• Amanda L Brooks, PT
• Jody Brooks, LPN

• Clinical Social Worker in Pontiac, IL
• Providers in Pontiac, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.