Active NPI
Amy Jackson
- Social Worker
- Grand Rapids, MI
National Provider Identifier
1992188239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6801103335
- Practice address
- 721 N Center Dr NW
Grand Rapids, MI 49544-8215 - Phone
- (616) 301-8000
- NPI assigned
- Jul 6, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6802088547 | MI | |
| Clinical Social Worker | 1041C0700X | 6801103335 | MI | |
| Social Worker | 104100000X | 6801103335 | MI | Primary |
Addresses
Primary practice location
721 N Center Dr NW
Grand Rapids, MI 49544-8215
Mailing address
1823 Francis Ave SE
Grand Rapids, MI 49507-2418
Other practice location 1
414 S Burdick St
Suite 200
Kalamazoo, MI 49007-6219
Phone (269) 615-1736
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6801103335 | Other | MI | LIMITED LICENSE |
| 6802088547 | Other | MI | LLBSW |
Other names 1
- Amy J Jackson
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
| License | State | Type | Specialty |
|---|---|---|---|
| 6801103335 | MI | MD | Social Worker |
| 6802088547 | MI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1436140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541635200000",
"number": "1992188239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1823 FRANCIS AVE SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495072418"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "721 N CENTER DR NW",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495448215",
"telephone_number": "616-301-8000"
}
],
"practiceLocations": [
{
"address_1": "414 S Burdick St",
"address_2": "Suite 200",
"address_purpose": "LOCATION",
"city": "Kalamazoo",
"state": "MI",
"postal_code": "490076219",
"country_code": "US",
"telephone_number": "269-615-1736",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "AMY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-07-06",
"last_updated": "2018-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6802088547",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801103335",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6801103335",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LIMITED LICENSE",
"identifier": "6801103335",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LLBSW",
"identifier": "6802088547",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "AMY",
"last_name": "JACKSON",
"middle_name": "J",
"credential": "LLMSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.