Individual provider Active NPI

Jennifer Michelle Dejong

  • Social Worker
  • Plano, TX
National Provider Identifier
1861090680
Registry record updated Jun 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Practice address
720 E Park Blvd Ste 204
Plano, TX 75074-8802
Phone
(469) 342-3468
NPI assigned
Oct 14, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2026

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 Primary

Addresses

Primary practice location

720 E Park Blvd Ste 204
Plano, TX 75074-8802

Mailing address

1817 E Grauwyler Rd Apt 164
Irving, TX 75061-3021
Phone (972) 730-6655

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20250224002040 TX Practitioner - Clinical Social Worker 0648790428 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CCNT IncGroup PAC ID 3173809621, 16 clinicians

Practice addresses (Care Compare)

720 E Park Blvd
204 Counseling Center of North Texas
Plano, TX 75074-8802
Phone (469) 342-3468

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
103393TXMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
CCNT Inc. CurrentSince Dec 31, 2024 Accepting new patients

Locations

720 E Park Blvd
Ste 204
Plano, TX 75074
Phone (469) 342-3468

303 S Highway 78
Ste 100
Wylie, TX 75098
Phone (469) 342-3468

303 S Highway 78
Ste 103
Wylie, TX 75098
Phone (469) 342-3468

Organizations & group practices 1

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": "1602633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782086400000",
    "number": "1861090680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1817 E GRAUWYLER RD APT 164",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750613021",
            "telephone_number": "972-730-6655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 E PARK BLVD STE 204",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750748802",
            "telephone_number": "469-342-3468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEJONG",
        "first_name": "JENNIFER",
        "middle_name": "MICHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-14",
        "last_updated": "2026-06-22",
        "certification_date": "2026-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plano, TX

Sources for this page

Verify at the official NPI Registry.