Jaclyn Andersen, CSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

77503153502 Issued in UT

Practice address

380 W 1400 N
Logan, UT 84341-6813

Phone

(435) 752-8880

NPI assigned

Jul 13, 2011

Last updated

Jul 13, 2011By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bear River Mental Health Services Inc

  • Mental Health Counselor
  • Logan, UT
  • NPI 1285736553
  Medicare reassignment NPD
• Elevated Perspective

  • Clinical Social Worker
  • Logan, UT
  • NPI 1548939911
  NPD (past)

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

{
    "created_epoch": "1310515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310515200000",
    "number": "1982992798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "297 W 1000 N",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843212239",
            "telephone_number": "435-757-0917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 W 1400 N",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843416813",
            "telephone_number": "435-752-8880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSEN",
        "first_name": "JACLYN",
        "credential": "CSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-13",
        "last_updated": "2011-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "UT",
            "license": "77503153502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blake Denver Altom, M.S., MFT INTERN
• Deborah Lynn Amundson, M.ED./CCC-SLP
• Blaine P Andersen, MD
• Candace L Andersen
• Colby J Andersen, P.A.
• Jay P Andersen, OTR/L
• Megan Lynn Andersen, CSW, CTRS
• Allan David Anderson, MD
• Amelia S. Anderson, MD
• Andrew Justin Anderson, LMT, PTA

• Social Worker in Logan, UT
• Providers in Logan, UT by specialty
• Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.