Jacquelyn Wiman, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW60293057 Issued in WA

Practice address

1007 Koala Dr
Omak, WA 98841-9247

Phone

(509) 826-6191

Fax

(509) 826-8416

NPI assigned

Jul 22, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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 and National Provider Directory roles.

• Okanogan Behavioral Healthcare

  • Mental Health Counselor
  • Omak, WA
  • NPI 1154324929
  Medicare reassignment
• Mindcare Solutions of Texas PA

  • Psychiatry Physician
  • Austin, TX
  • NPI 1396290730
  NPD
• Okanogan Behavioral Healthcare

  • Community/Behavioral Health Agency
  • Omak, WA
  • NPI 1366794034
  NPD (past)

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

{
    "created_epoch": "1437523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706745600000",
    "number": "1831574680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 KOALA DR",
            "city": "OMAK",
            "state": "WA",
            "postal_code": "988419247",
            "telephone_number": "509-826-6191",
            "fax_number": "509-826-8416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 KOALA DR",
            "city": "OMAK",
            "state": "WA",
            "postal_code": "988419247",
            "telephone_number": "509-826-6191",
            "fax_number": "509-826-8416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIMAN",
        "first_name": "JACQUELYN",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-22",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW60293057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ute M Wilcox, MD
• Gabriel Kane Williams, MD
• Ryan Willis
• Dempsey Lee Wilson
• Vanessa R Wilson, L.M.P
• Donna Louise Wochadlo, L.M.P.
• Antoinette Work, MHP, LMHCA
• Brandy Yearout, MSW
• Lisa M Yusi
• Zachary D. Meyer

• Clinical Social Worker in Omak, WA
• Providers in Omak, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 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.