Active NPI
Jenna Mathis, LMSW
- Clinical Social Worker
- Portage, MI
National Provider Identifier
1841052263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6801116562
- Practice address
- 2680 W Centre Ave
Portage, MI 49024-4828 - Phone
- (269) 324-0576
- NPI assigned
- Jan 30, 2024
- 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 | 6801116562 | MI | Primary |
Addresses
Primary practice location
2680 W Centre Ave
Portage, MI 49024-4828
Mailing address
2680 W Centre Ave
Portage, MI 49024-4828
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801116562 | MI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1706572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706572800000",
"number": "1841052263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2680 W CENTRE AVE",
"city": "PORTAGE",
"state": "MI",
"postal_code": "490244828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2680 W CENTRE AVE",
"city": "PORTAGE",
"state": "MI",
"postal_code": "490244828",
"telephone_number": "269-324-0576"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHIS",
"first_name": "JENNA",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-30",
"last_updated": "2024-01-30",
"certification_date": "2024-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801116562",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portage, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.