Samella Jolly, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

10231-123 Issued in WI

Practice address

2800 E Enterprise Ave Ste 333
Appleton, WI 54913-7889

Phone

(920) 200-5594

NPI assigned

Jul 8, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• SJ Community Collective, LLC

  • Clinical Social Worker
  • Appleton, WI
  • NPI 1225988462
  NPD Authorized official

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

{
    "created_epoch": "1625702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784851200000",
    "number": "1821669037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 E ENTERPRISE AVE STE 333",
            "address_2": "SUITE 333",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549137889",
            "telephone_number": "920-200-5594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 E ENTERPRISE AVE STE 333",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549137889",
            "telephone_number": "920-200-5594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOLLY",
        "first_name": "SAMELLA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-08",
        "last_updated": "2026-07-24",
        "certification_date": "2026-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "127301",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34012465A",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.031153",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "131275-121",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "10231-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thea Angela Johnson, MS
• Jessica R Johnston-Rickert, MD
• Lauren Johnston
• Michele Marie Johnston
• Rachel M Jolivard, FNP-C
• Ann Jones, MD
• Brenda Jones, LCSW
• Dawn Shannon Jones, OTR
• Katy Lynn Jones, M.S., LPC
• Maria Lea Jones

• Clinical Social Worker in Appleton, WI
• Providers in Appleton, 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 Jul 24, 2026; 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.