NPIMap

Individual provider Active NPI

Jacob Wicks

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1922483296
Registry record updated Feb 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L8045 Issued in OR
Practice address
2800 N Vancouver Ave Ste 165
Portland, OR 97227-1644
Phone
(503) 413-2902
Fax
(503) 413-5220
NPI assigned
Jul 28, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 4, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 0858761 NY
Social Worker 104100000X
Clinical Social Worker 1041C0700X L8045 OR Primary

Addresses

Primary practice location

2800 N Vancouver Ave Ste 165
Portland, OR 97227-1644

Mailing address

PO Box 4399
Portland, OR 97208-4399
Phone (503) 413-3900

Other practice location 1

11035 NE Sandy Blvd
Portland, OR 97220-2553
Phone (503) 258-4200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
0858761NYMDSocial Worker
L8045ORMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
10 Colors Counseling LLC Clinical Current Accepting new patients
Morrison Child and Family Services Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1438041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580774400000",
    "number": "1922483296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4399",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972084399",
            "telephone_number": "503-413-3900",
            "fax_number": "503-413-3710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 N VANCOUVER AVE STE 165",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271644",
            "telephone_number": "503-413-2902",
            "fax_number": "503-413-5220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11035 NE Sandy Blvd",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972202553",
            "country_code": "US",
            "telephone_number": "503-258-4200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WICKS",
        "first_name": "JACOB",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-28",
        "last_updated": "2020-02-04",
        "certification_date": "2020-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "0858761",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L8045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2020; 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.