Active NPI
Jessica Lynn Elliott, MSW, LCSW
- Clinical Social Worker
- Mukwonago, WI
National Provider Identifier
1821201146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 7028-123
- Practice address
- W247S10395 Center Dr
Mukwonago, WI 53149-9166 - Phone
- (262) 662-5900
- Fax
- (262) 662-5688
- NPI assigned
- May 7, 2007
- Last updated
- Nov 10, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 7028-123 | WI | Primary |
Addresses
Primary practice location
W247S10395 Center Dr
Mukwonago, WI 53149-9166
Mailing address
1337 Redwing Dr
Oconomowoc, WI 53066-2388
Phone (414) 698-9872
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40962200 | Medicaid | WI |
Other names 1
- Miss Jessica Lynn Ray
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Norris Adolescent Center | Past | Accepting new patients | |
| Norris Adolescent Center | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Emotionally Disturbed Childrens' Residential Treatment Facility
- Mukwonago, WI
- NPI 1235304056
-
- Emotionally Disturbed Childrens' Residential Treatment Facility
- Mukwonago, WI
- NPI 1841466083
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604966400000",
"number": "1821201146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1337 REDWING DR",
"city": "OCONOMOWOC",
"state": "WI",
"postal_code": "530662388",
"telephone_number": "414-698-9872"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "W247S10395 CENTER DR",
"city": "MUKWONAGO",
"state": "WI",
"postal_code": "531499166",
"telephone_number": "262-662-5900",
"fax_number": "262-662-5688"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIOTT",
"first_name": "JESSICA",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "MSW, LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-07",
"last_updated": "2020-11-10",
"certification_date": "2020-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "7028-123",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40962200",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JESSICA",
"last_name": "RAY",
"middle_name": "LYNN",
"prefix": "MISS",
"credential": "MSW, LCSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Mukwonago, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.