Jessica J. Wolke Licsw Inc

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

ISW01554 Issued in RI

Legal business name

JESSICA J. WOLKE LICSW INC

Practice address

21 Canal St Ste 201
Westerly, RI 02891-1587

Phone

(401) 596-8830

NPI assigned

Nov 22, 2017

Organization subpart

No

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

Authorized official

Name

Tonya Cassell

Title

Billing Agent

Phone

(860) 405-4951

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jessica J. Wolke Former legal business name

Medicare fee-for-service enrollment

Enrolled in RI

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jessica Johanna Wolke, LICSW

  • Clinical Social Worker
  • Westerly, RI
  • NPI 1073777298
  Medicare reassignment NPD

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

{
    "created_epoch": "1511308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704067200000",
    "number": "1891209284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 CANAL ST STE 201",
            "city": "WESTERLY",
            "state": "RI",
            "postal_code": "028911587",
            "telephone_number": "401-596-2475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 CANAL ST STE 201",
            "city": "WESTERLY",
            "state": "RI",
            "postal_code": "028911587",
            "telephone_number": "401-596-8830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESSICA J. WOLKE LICSW INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-22",
        "last_updated": "2024-01-01",
        "certification_date": "2024-01-01",
        "status": "A",
        "authorized_official_last_name": "CASSELL",
        "authorized_official_first_name": "TONYA",
        "authorized_official_title_or_position": "BILLING AGENT",
        "authorized_official_telephone_number": "860-405-4951"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW01554",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "U300404468",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jessica J. Wolke",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Clinical Social Worker in Westerly, RI
• Providers in Westerly, RI by specialty
• Clinical Social Worker in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.