Individual provider Active NPI

Jacqueline Weeden, LCSW

  • Social Worker
  • Port Washington, WI
National Provider Identifier
1821005406
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
7199-123 Issued in WI
Practice address
1317 W Grand Ave
Port Washington, WI 53074-2075
Phone
(262) 284-5789
Fax
(262) 284-5907
NPI assigned
Aug 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 7199-123 WI Primary

Addresses

Primary practice location

1317 W Grand Ave
Port Washington, WI 53074-2075

Mailing address

1317 W Grand Ave
Port Washington, WI 53074-2075
Phone (262) 284-5789

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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

Enrollment IDStateProvider typePAC IDDetails
I20050823000951 WI Practitioner - Clinical Social Worker 6204867880 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Weeden and Associates, LLCGroup PAC ID 9830369206, 2 clinicians

Practice addresses (Care Compare)

W67N222 Evergreen Blvd
Suite 111
Cedarburg, WI 53012-2650
Phone (262) 375-9225

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Weeden & Associates, LLC CurrentSince Jun 21, 2011 Accepting new patients
Northshore Clinic & Consultants, Inc. PastSince Apr 20, 2009 Accepting new patients

Locations

W67N222 Evergreen Blvd
Cedarburg, WI 53012
Phone (262) 375-9225

W67N222 Evergreen Blvd
Ste 111
Cedarburg, WI 53012
Phone (262) 375-9222

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": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821005406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 W GRAND AVE",
            "city": "PORT WASHINGTON",
            "state": "WI",
            "postal_code": "530742075",
            "telephone_number": "262-284-5789",
            "fax_number": "262-284-5907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 W GRAND AVE",
            "city": "PORT WASHINGTON",
            "state": "WI",
            "postal_code": "530742075",
            "telephone_number": "262-284-5789",
            "fax_number": "262-284-5907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEEDEN",
        "first_name": "JACQUELINE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "7199-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Washington, WI

Sources for this page

Verify at the official NPI Registry.