Jackie Marie Wood, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CC01773 Issued in MN

Practice address

710 S 2ND St
Mankato, MN 56001-3810

Phone

(507) 625-7660

Fax

(507) 625-8998

NPI assigned

May 3, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

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

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lutheran Social Service of Minnesota

  • Community/Behavioral Health Agency
  • Saint Cloud, MN
  • NPI 1629192430
  Medicare reassignment NPD
• Counseling Services of Southern Minnesota, Inc

  • Clinical Social Worker
  • Saint Peter, MN
  • NPI 1962557496
  NPD (past)

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

{
    "created_epoch": "1525305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723420800000",
    "number": "1790274959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 S 2ND ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560013810",
            "telephone_number": "507-625-7660",
            "fax_number": "507-625-8998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 S 2ND ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560013810",
            "telephone_number": "507-625-7660",
            "fax_number": "507-625-8998"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 3rd Ave NE",
            "address_purpose": "LOCATION",
            "city": "Waseca",
            "state": "MN",
            "postal_code": "560933301",
            "country_code": "US",
            "telephone_number": "507-625-7660",
            "fax_number": "507-625-8998",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOOD",
        "first_name": "JACKIE",
        "middle_name": "MARIE",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-03",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC01773",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "CC01773",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED PROFESSIONAL CLINICAL COUNSELOR",
            "identifier": "CC01773",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Women's Vitality & Fertility PLLC
• Thea Elizabeth Wondra, MS. CCC-SLP
• Andrew Joshua Wong, D.D.S.
• Melanie Imker Wong
• Bryan T Wood, MD
• Rachel Worley, PT
• Wendy R Woster, MD
• Darla J Wrage, MD
• Noah Lynn Wride, M.D.
• Taurean Wright-Ervin

• Mental Health Counselor in Mankato, MN
• Providers in Mankato, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; 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.