Active NPI
Shannon J Wilkowski
- Marriage & Family Therapist
- San Jose, CA
National Provider Identifier
1881309508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 80839
- Practice address
- 1210 S Bascom Ave Ste 114
San Jose, CA 95128-3535 - Phone
- (650) 898-7505
- NPI assigned
- Jan 17, 2023
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 80839 | CA | Primary |
Addresses
Primary practice location
1210 S Bascom Ave Ste 114
San Jose, CA 95128-3535
Mailing address
1210 S Bascom Ave Ste 114
San Jose, CA 95128-3535
Phone (650) 898-7505
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 80839 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1673913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676419200000",
"number": "1881309508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1210 S BASCOM AVE STE 114",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951283535",
"telephone_number": "650-898-7505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1210 S BASCOM AVE STE 114",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951283535",
"telephone_number": "650-898-7505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILKOWSKI",
"first_name": "SHANNON",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-01-17",
"last_updated": "2023-02-15",
"certification_date": "2023-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "80839",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.