MS. JACQUELYN MAE BLOCK MFT, LCSW, LMFT
NPI 1336360429
Social Worker - Clinical in Fond Du Lac, WI

Q: What is Jacquelyn Block's NPI number?

The NPI number for Jacquelyn Block is 1336360429. It was assigned to this individual provider in the NPPES registry on May 2, 2007.

Q: What is Jacquelyn Block's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Q: When was this NPI record last updated?

The NPPES record for Jacquelyn Block was last updated on December 16, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 02, 2007PECOS EnrolledAccepts Medicare Assignment

430 E DIVISION ST, FOND DU LAC, WI 54935(920) 926-4209 Get Directions Write a Review

NPPES record last updated: December 16, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 16, 2020, Aug 13, 2019 (2 updates tracked since 2019).

On this page

About Ms. Jacquelyn Mae Block Mft, Lcsw, Lmft NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. JACQUELYN MAE BLOCK MFT, LCSW, LMFT (NPI 1336360429) is an individual clinical provider in Fond Du Lac, Wisconsin, licensed in Wisconsin (2841-123) and active in the NPI registry since May 2007. She is enrolled in Medicare PECOS, is affiliated with St. Agnes Hospital Hospice, and is a graduate of Other (1990).

NPPES Registry Identity

NPI1336360429

Entity TypeIndividualFemale

Primary Taxonomy1041C0700X

Provider Legal NameMS. JACQUELYN MAE BLOCKCredential: MFT, LCSW, LMFT

Location Address430 E DIVISION STFond Du Lac, WI 54935-4560

Mailing Address420 E Division StFond Du Lac, WI 54935-4560 · (920) 926-4209

Phone(920) 926-4209

Sole ProprietorNo

Medical School CMSOtherGraduated 1990

Enumeration DateMay 2, 2007

Last NPPES UpdateDecember 16, 20202 updates tracked since enumeration

NPPES CertifiedDecember 16, 2020

✔ NPI 1336360429 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code1041C0700X

License✔ Licensed in WI · 2841-123

Definition

A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

Also ListedMarriage & Family TherapistTaxonomy 106H00000X · License 226-124 (WI)

430 E DIVISION ST, Fond Du Lac, WI 54935

Open in Google Maps ↗

Other Identifiers 2

Other226-124WI · Lmft

Other2841-123WI · Lcsw

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Medica, Network Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Ms. Jacquelyn Mae Block Mft, Lcsw, Lmft is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5890034771

PECOS Enrollment IDI20190312001399

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

St. Agnes Hospital Hospice

Acute Care Hospitals · Fond Du Lac, WI

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number520088

Location430 E Division StFond Du Lac, WI 54935 · Fond Du Lac County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 54935 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$0.00 typical visit price

range $53.90 – $163.24

Typical copayment $0.00 (range $13.47 – $40.81)

Most-billed visit code NA

Established Patient

$67.37 typical visit price

range $17.40 – $133.76

Typical copayment $16.84 (range $4.35 – $33.44)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CLAIRE ELIZABETH KRIZMAN

Counselor (Mental Health)