Jacqueline Ann Weydert, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

06609 Issued in IA

Practice address

200 4TH Ave W
Grinnell, IA 50112-1833

Phone

(641) 236-6137

NPI assigned

Jun 8, 2008

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

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

Specialty

Clinical Social Worker

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Family Life Counseling and Psychological Services LLCGroup PAC ID 5496649022, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Family Life Counseling and Psychological Services, LLC

  • Psychologist
  • O Fallon, MO
  • NPI 1851459473
  Medicare reassignment Care Compare group NPD
• Capstone Behavioral Healthcare, Inc

  • Community/Behavioral Health Agency
  • Newton, IA
  • NPI 1174598908
  NPD (past)
• Poweshiek County Mental Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Grinnell, IA
  • NPI 1528166360
  NPD (past)
• Sandhill Counseling and Consultation, LLC

  • Marriage & Family Therapist
  • O Fallon, MO
  • NPI 1992174759

  Clinical

  NPD (past)

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

{
    "created_epoch": "1212883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1227571200000",
    "number": "1871752436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 4TH AVE W",
            "city": "GRINNELL",
            "state": "IA",
            "postal_code": "501121833",
            "telephone_number": "641-236-6137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 4TH AVE W",
            "city": "GRINNELL",
            "state": "IA",
            "postal_code": "501121833",
            "telephone_number": "641-236-6137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEYDERT",
        "first_name": "JACQUELINE",
        "middle_name": "ANN",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-08",
        "last_updated": "2008-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "06609",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871752436",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Vine, M.A., TEMPORARY LMHC
• Jordan Dean Vos, DPT/ATC
• Janet Louise Walker, LISW
• Walmart Inc.
• Jeffrey Scott Wells, LMFT
• Savannah Wheeler, MS
• Joseph Whitman, DO
• Kristine Lynnette Wilder

• Clinical Social Worker in Grinnell, IA
• Providers in Grinnell, IA by specialty
• Clinical Social Worker in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2008; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.