Jacqueline Venesia McRae, ICS, SAC-IT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

18414-130 Issued in WI

Practice address

4810 Northwestern Ave
Mount Pleasant, WI 53406-1504

Phone

(262) 637-9984

Fax

(262) 637-9995

NPI assigned

Jun 27, 2018

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Lakeside Family Therapy Services LTD

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Racine, WI
  • NPI 1407998719

  Addiction (Substance Use Disorder)

  NPD Authorized official

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

{
    "created_epoch": "1530057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530057600000",
    "number": "1992290381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4810 NORTHWESTERN AVE",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534061504",
            "telephone_number": "262-637-9984",
            "fax_number": "262-637-9995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4810 NORTHWESTERN AVE",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534061504",
            "telephone_number": "262-637-9984",
            "fax_number": "262-637-9995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCRAE",
        "first_name": "JACQUELINE",
        "middle_name": "VENESIA",
        "credential": "ICS, SAC-IT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-27",
        "last_updated": "2018-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "18414-130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lanice McDonald
• Mackenzie McDonald, DC
• Erin McGee, OTR/L
• Samantha McGhee, M.S. CCC-SLP
• Alissa Marie McMahon, ALISSA MCMAHON, PA-C
• Julie Ann Mecham, MPT
• Medical Support Services Inc
• Haley E. Meekma, DPT
• Anthony Megna
• Elizabeth Melis, PT

• Addiction (Substance Use Disorder) Counselor in Mount Pleasant, WI
• Providers in Mount Pleasant, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 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.

Verify at the official NPI Registry.