Jessica C Wallner

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CC5729 Issued in ME

Practice address

221 North St
Saco, ME 04072-1843

Phone

(207) 590-4310

NPI assigned

Nov 14, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Open Gate LLC

  • Adult Mental Health Clinic/Center
  • Saco, ME
  • NPI 1164298360
  NPD Authorized official

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

{
    "created_epoch": "1542153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701216000000",
    "number": "1871062281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12",
            "city": "SACO",
            "state": "ME",
            "postal_code": "040720012",
            "telephone_number": "207-590-4310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 NORTH ST",
            "city": "SACO",
            "state": "ME",
            "postal_code": "040721843",
            "telephone_number": "207-590-4310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLNER",
        "first_name": "JESSICA",
        "middle_name": "C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-14",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ME",
            "license": "XL5141",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ME",
            "license": "CC5729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kasey M Villeneuve, LMSW-CC
• Michal S Wagner, LMSW
• Walgreen Eastern Co Inc
• Alec Walker, PA-C
• Keith C Walker, L.C.S.W. LLC
• Marion D Walrath, O.T
• Autumn Marie Walsh
• Kristen Walther, LCSW, LADC
• Sandra J Ward, LMSW-CC
• Wardwell Assisted Living Services, Inc

• Professional Counselor in Saco, ME
• Providers in Saco, ME by specialty
• Professional Counselor in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2023; 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.