Active NPI
Jennifer Kridelbaugh
- Mental Health Counselor
- Waynesville, MO
National Provider Identifier
1003107228
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 2009035448
- Practice address
- 1000 Hospital Rd
Waynesville, MO 65583-2634 - Phone
- (573) 774-5353
- NPI assigned
- Apr 21, 2011
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 2009035448 | MO | Primary |
Addresses
Primary practice location
1000 Hospital Rd
Waynesville, MO 65583-2634
Mailing address
1000 Hospital Rd
Waynesville, MO 65583-2634
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 |
|---|---|---|---|
| 2009035448 | MO | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Woodridge of Missouri, Inc. | Past | Accepting new patients |
Networks
- devoted network organization-734447cc-691b-4aa7-a112-9c9c8698dcc9
- devoted network organization-27eb9117-6975-449a-a7ad-909243995ddc
Organizations & group practices 1
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.
-
- Emotionally Disturbed Childrens' Residential Treatment Facility
- Waynesville, MO
- NPI 1174662720
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1303344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303344000000",
"number": "1003107228",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 HOSPITAL RD",
"city": "WAYNESVILLE",
"state": "MO",
"postal_code": "655832634"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 HOSPITAL RD",
"city": "WAYNESVILLE",
"state": "MO",
"postal_code": "655832634",
"telephone_number": "573-774-5353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRIDELBAUGH",
"first_name": "JENNIFER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-04-21",
"last_updated": "2011-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MO",
"license": "2009035448",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waynesville, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.