Jenna Mae Dalgord, MSW, APSW, SAC-IT

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

135092 Issued in WI

Practice address

300 Crooks St
Green Bay, WI 54301-4527

Phone

(920) 436-6800

Fax

(920) 437-3540

NPI assigned

Dec 20, 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 3

Other names 1

• Jenna M Sides Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Family Services of Northeast Wisconsin Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Menasha, WI
  • NPI 1275525925
  NPD (past)
• Family Services of Northeast Wisconsin Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Green Bay, WI
  • NPI 1467453167
  NPD (past)
• Great Lakes Recovery Centers

  • Children's Substance Abuse Rehabilitation Facility
  • Negaunee, MI
  • NPI 1669899241
  NPD (past)
• Great Lakes Recovery Centers

  • Substance Abuse Rehabilitation Facility
  • Ironwood, MI
  • NPI 1821267956
  NPD (past)

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

{
    "created_epoch": "1545264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739404800000",
    "number": "1801368493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22308",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052308",
            "telephone_number": "920-436-6800",
            "fax_number": "920-437-3540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 CROOKS ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543014527",
            "telephone_number": "920-436-6800",
            "fax_number": "920-437-3540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALGORD",
        "first_name": "JENNA",
        "middle_name": "MAE",
        "credential": "MSW, APSW, SAC-IT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-20",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "20765",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "135092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "135092",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1801368493",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE SAC-IT",
            "identifier": "20765",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNA",
            "last_name": "SIDES",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Louis Alan Dainty, MD
• Charles F Dais II, M.D.
• Daniel L Dale, M.D.
• James G Dalebroux, RN
• Katie Dalebroux, PHARMD
• Kelly Dallaire, LPC
• Sarah Dallas, COTA
• Tracy Virginia Dalton, PHARMD
• Ashley Marie Damp
• Karl Alexander Damroth, M.D.

• Clinical Social Worker in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; 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.