JEANIE MICKELSEN (NPI# 1710510136) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710510136 |
| Entity Type | Individual |
| Full Name | JEANIE MICKELSEN |
| Credential | LCPC |
| Practice Address |
1802 S Mattis Ave Champaign IL 61821-5923 |
| Mailing Address |
611 W. Park St. Fapc Urbana IL 61801 |
| Practice Telephone | 2173831850 |
| Practice Fax Number | 2173833439 |
| Enumeration Date | 2020-02-13 |
| Last Update Date | 2020-02-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 104100000X | Social Worker | Behavioral Health & Social Service Providers |
| Street Address |
1802 S MATTIS AVE |
| City | CHAMPAIGN |
| State | IL |
| Zip Code | 61821-5923 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568459030 | Bart Wayne Gastwirth | Podiatrist | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2005-09-30 |
| 1982230124 | Bradley Thompson | Registered Nurse | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2020-03-19 |
| 1003456369 | Rachael D Rubin | Psychologist | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2020-01-14 |
| 1114563640 | Mary K Kiesewetter | Nurse Practitioner | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2019-11-19 |
| 1083255343 | Lisa A. Ellingwood | Registered Nurse | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2019-10-07 |
| 1841843539 | Rakisha Wilks | Nurse Practitioner | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2019-07-22 |
| 1558869081 | Kristin E Thies | Psychologist | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2018-01-30 |
| 1215463971 | Mercy E Eigbike | Psychiatry & Neurology | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2017-05-02 |
| 1770034878 | Tammie Roedl | Social Worker | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2016-10-24 |
| 1881080372 | Deanna Kane | Nurse Practitioner | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2015-04-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326532888 | Cunningham Children's Home of Urbana Il | Residential Treatment Facility, Emotionally Disturbed Children | 1303 N. Cunningham Avenue, Urbana, IL 61821 | 2018-06-19 |
| 1184008708 | Seunghyun Jae | Dentist | 1905 W Springfield Ave, Champaign, IL 61821 | 2015-07-14 |
| 1457698169 | Mohamad Ata | Registered Nurse | 1802 S. Mattis, Champaign, IL 61821 | 2013-01-15 |
| 1609124338 | Lolitia Rosanna Newman | Social Worker | 1508 Powers Ln., Champaign, IL 61821 | 2012-08-28 |
| 1679850887 | Kirk Donald Gohsman | Counselor | 106 S. Country Fair Drive, Suite C, Champaign, IL 61821 | 2011-11-16 |
| 1598054777 | Delbert William Nelson Jr. | Psychiatry & Neurology | 2115 Galen Dr, Champaign, IL 61821 | 2011-03-28 |
| 1790946929 | Rdi Vein LLC | Clinic/Center | 2502 Galen Drive, Suite 101, Champaign, IL 61821 | 2008-06-20 |
| 1366620064 | Advanced Aesthetics Surgery & Laser Center, P.C. | Clinic/Center | 2111 West Park Ct., Champaign, IL 61821 | 2008-02-05 |
| 1033398482 | Huey's Home Medical, Inc | Durable Medical Equipment & Medical Supplies | 1207 S Mattis Ave Ste 1, Champaign, IL 61821 | 2007-11-01 |
| 1265630537 | Elizabeth Catherine Tingley | Psychologist | Department of Psychiatry and Psychology-carle Physician, 1802 S. Mattis, Champaign, IL 61821 | 2007-07-06 |
| Find all providers in zip 61821 | ||||
| Taxonomy Code | 104100000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public. |
| Notes: Source: National Association of Social Workers, 2009 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609427269 | Willow Counseling LLC | Social Worker | 1415 Cobblestone Way, Champaign, IL 61822-2068 | 2019-09-25 |
| 1003395831 | Kevin Joseph Elliott | Social Worker | 1807 S Neil St, Champaign, IL 61820-7215 | 2018-08-13 |
| 1033570437 | Rani Brandon | Social Worker | 401 Springfield, Champaign, IL 61820-1911 | 2016-03-11 |
| 1497156954 | Tearra Mcdade | Social Worker | 905 Berwick Dr, 2, Champaign, IL 61822-1885 | 2014-09-15 |
| 1932531084 | Rochelle Spies | Social Worker | 1216 W John St, Champaign, IL 61821-3804 | 2013-07-31 |
| 1881037513 | Kelly Marie Mcnellis | Social Worker | 703 W Church St, Apt H, Champaign, IL 61820-3352 | 2013-04-11 |
| 1073856159 | Alicia Lorine Williams | Social Worker | 202 West Park St, Champaign, IL 61820-3723 | 2013-03-27 |
| 1750623302 | Sharnice Denine Jones | Social Worker | 21 Thatcham Dr Apt 12, Champaign, IL 61820-2380 | 2013-03-21 |
| 1609124338 | Lolitia Rosanna Newman | Social Worker | 1508 Powers Ln., Champaign, IL 61821 | 2012-08-28 |
| 1912215252 | Candace Logan | Social Worker | 311 W White St, Champaign, IL 61820-4805 | 2010-09-21 |
| Find all providers in CHAMPAIGN | ||||
Please comment or provide details below to improve the information on JEANIE MICKELSEN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.