Kendra Jackimczyk, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-10166 Issued in AZ

Practice address

7364 E Nopal Ave
Mesa, AZ 85209-7220

Phone

(480) 495-7979

NPI assigned

Jan 8, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kendra.jackimczyk.1@11818.direct.athenahealth.com

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.

• Circle the City

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1346588316
  Medicare reassignment NPD
• Circle the City

  • Community/Retail Pharmacy
  • Phoenix, AZ
  • NPI 1144093972
  NPD

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550188800000",
    "number": "1780732990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7364 E NOPAL AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852097220",
            "telephone_number": "480-495-7979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7364 E NOPAL AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852097220",
            "telephone_number": "480-495-7979"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "140 S Gilbert Rd",
            "address_purpose": "LOCATION",
            "city": "Gilbert",
            "state": "AZ",
            "postal_code": "852961016",
            "country_code": "US",
            "telephone_number": "480-497-3300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKIMCZYK",
        "first_name": "KENDRA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-08",
        "last_updated": "2019-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "LCSW-10166",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "687296",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jamil Jaber, MD
• Amal A. Jabra, M.D.
• Mariela Jacinto
• Jack R Cavalcant MD PC
• Jack Ryan Recovery Centers
• Kimberly Jackowski, LAC
• Lorin Eric Jackrel, DMD
• Timothy Jacks, D.O.
• Alain Jeanine Jackson
• Casiel Dominique Jackson, LAC

• Clinical Social Worker in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Clinical Social Worker in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2019; 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.