JACLYN ANNETTE PETERSEN MSW
NPI 1780273102
Social Worker - Clinical in Champaign, IL

Q: What is Jaclyn Petersen's NPI number?

The NPI number for Jaclyn Petersen is 1780273102. It was assigned to this individual provider in the NPPES registry on January 11, 2021. The provider is also known as Jax Annette Petersen Msw.

Q: What is Jaclyn Petersen'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 Jaclyn Petersen was last updated on January 11, 2021. 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 January 11, 2021

309 W CLARK ST, CHAMPAIGN, IL 61820(217) 398-9066(217) 398-9077 Get Directions Write a Review

NPPES record last updated: January 11, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Jaclyn Annette Petersen Msw NPPES

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

JACLYN ANNETTE PETERSEN MSW (NPI 1780273102) is an individual clinical provider in Champaign, Illinois, licensed in Illinois (149.022485) and active in the NPI registry since January 2021.

NPPES Registry Identity

NPI1780273102

Entity TypeIndividualFemale

Primary Taxonomy1041C0700X

Provider Legal NameJACLYN ANNETTE PETERSENCredential: MSW

Location Address309 W CLARK STChampaign, IL 61820-4637

Mailing Address309 W Clark StChampaign, IL 61820-4637 · (217) 398-9066 · Fax (217) 398-9077

Phone(217) 398-9066

Fax(217) 398-9077

Sole ProprietorNo

Enumeration DateJanuary 11, 2021

NPPES CertifiedJanuary 11, 2021

✔ NPI 1780273102 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code1041C0700X

License✔ Licensed in IL · 149.022485

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.

309 W CLARK ST, Champaign, IL 61820

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Other Names 1

Professional Name (2)Jax Annette Petersen Msw

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.

RACHEL COOPER YUHAS LCPC

Counselor (Professional)