Jacqueline Juanita Madison, DMIN,MA, CAPS, LPC

Primary specialty

Pastoral CounselorTaxonomy code 101YP1600X

Practice address

5655 Kingsbury Ave Apt 909
Saint Louis, MO 63112-1874

Phone

(314) 740-0903

NPI assigned

Jan 25, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 6

Addresses

Other names 1

• Dr. Jacqueline J Madison Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1485302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684713600000",
    "number": "1972040210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5343 BELLEVILLE CROSSING ST # 2079",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622263108",
            "telephone_number": "314-740-0903",
            "fax_number": "314-448-1481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5655 KINGSBURY AVE APT 909",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631121874",
            "telephone_number": "314-740-0903"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 Agnes Dr",
            "address_purpose": "LOCATION",
            "city": "Cahokia",
            "state": "IL",
            "postal_code": "622062714",
            "country_code": "US",
            "telephone_number": "314-201-5908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MADISON",
        "first_name": "JACQUELINE",
        "middle_name": "JUANITA",
        "name_prefix": "Dr.",
        "credential": "DMIN,MA, CAPS, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-25",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178.012744",
            "primary": false
        },
        {
            "code": "101YP1600X",
            "taxonomy_group": "",
            "desc": "Counselor, Pastoral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": "1090",
            "primary": false
        },
        {
            "code": "101YP1600X",
            "taxonomy_group": "",
            "desc": "Counselor, Pastoral",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "MADISON",
            "middle_name": "J",
            "prefix": "DR.",
            "credential": "REV. DR.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Adam Madej, DO
• Irvianny Rosario Madera, MD
• Madhuram LLC
• Katherine Madigan, DO
• Sarah Lillian Madira
• Madmar, LLC
• William Frank Madosky, D.C.
• Brian Scott Madrid, RN
• Sabrina Corin Madrigal, MD
• Erik Christian Madsen, MD, PHD

• Pastoral Counselor in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Pastoral Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; 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.