Jennifer Lynn Shields, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6802078818 Issued in MI

Practice address

410 W University Dr Ste 130
Rochester, MI 48307-1938

Phone

(248) 892-4887

NPI assigned

Mar 5, 2007

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

• Jennifer Lynn Willis Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 10, 2020 through Jan 10, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570752000000",
    "number": "1972632743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 W UNIVERSITY DR STE 130",
            "city": "ROCHESTER",
            "state": "MI",
            "postal_code": "483071938",
            "telephone_number": "248-892-4887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 W UNIVERSITY DR STE 130",
            "city": "ROCHESTER",
            "state": "MI",
            "postal_code": "483071938",
            "telephone_number": "248-892-4887"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "114 Orchard Lake Rd",
            "address_purpose": "LOCATION",
            "city": "Pontiac",
            "state": "MI",
            "postal_code": "483412244",
            "country_code": "US",
            "telephone_number": "248-858-7766 x277",
            "fax_number": "248-858-7201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIELDS",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-05",
        "last_updated": "2019-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6802078818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "WILLIS",
            "middle_name": "LYNN",
            "credential": "LBSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Robert H Shaw, PHD
• Shelley R. Knowles, MD, PLLC
• Shen Dao, LLC
• Daniel Shepherd, DMIN, LMFT
• Cheryl Sherrod
• Michael Elias Shiha, D.C.
• Nathan Shin
• Tania Shiva, PT
• Lauryn Shugars, LPC
• Jeffrey M Shulak, MD

• Clinical Social Worker in Rochester, MI
• Providers in Rochester, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; 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.

Verify at the official NPI Registry.