Jaclynn Brock, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

1073-124 Issued in WI

Practice address

501 S Cherry Ave Ste 5
Marshfield, WI 54449-4263

Phone

(715) 486-8302

Fax

(715) 486-9253

NPI assigned

May 6, 2016

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 names 1

• Jaclynn M Koble Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1462492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462492800000",
    "number": "1871949073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S CHERRY AVE STE 5",
            "city": "MARSHFIELD",
            "state": "WI",
            "postal_code": "544494263",
            "telephone_number": "715-486-8302",
            "fax_number": "715-486-9253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S CHERRY AVE STE 5",
            "city": "MARSHFIELD",
            "state": "WI",
            "postal_code": "544494263",
            "telephone_number": "715-486-8302",
            "fax_number": "715-486-9253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCK",
        "first_name": "JACLYNN",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-06",
        "last_updated": "2016-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WI",
            "license": "1073-124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYNN",
            "last_name": "KOBLE",
            "middle_name": "M",
            "credential": "MFT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joshua M. Brettingen, CRNA
• Mark E Brickley, DC
• Brideway Home Health
• Jacob Briese, DDS
• Dean Brix, PT
• Tracy Brock, APRN
• Tom Brosnahan, PA
• Sara Lee Brost, MS CCC SLP
• Brian M Brotz, MD
• Chris M Brown, COTA

• Marriage & Family Therapist in Marshfield, WI
• Providers in Marshfield, WI by specialty
• Marriage & Family Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2016; 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.