Kenneth George Fournier, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

5416 Issued in MN

Practice address

500 N US Highway 89
Prescott, AZ 86313-5001

Phone

(928) 445-4860

Fax

(928) 776-6116

NPI assigned

Jun 26, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Prescott Vamc

  • Department of Veterans Affairs (VA) Pharmacy
  • Prescott, AZ
  • NPI 1801854328
  NPD (past)

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

{
    "created_epoch": "1340668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340668800000",
    "number": "1003170838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N. HIGHWAY 89",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863130000",
            "telephone_number": "928-445-4860",
            "fax_number": "928-445-6116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N US HIGHWAY 89",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863135001",
            "telephone_number": "928-445-4860",
            "fax_number": "928-776-6116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOURNIER",
        "first_name": "KENNETH",
        "middle_name": "GEORGE",
        "name_prefix": "Mr.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-26",
        "last_updated": "2012-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "5416",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "13543",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Forefront Dermatology, S.C. (Arizona Dermatology Group, a Forefront Dermatology Practice)
• Forefront Dermatology, S.C. (Arizona Dermatology Group, a Forefront Dermatology Practice)
• Shahla Forootan, M.D.
• Jocelyn Foster
• Kenton Guy Foundas, P.T.
• Drelan Che-Stewart Fowler, PA-C
• Fox Rehabilitation Services Az LLC
• Laura Franco
• Frank Iorio MD
• Matthew G. Frankel, MD

• Clinical Social Worker in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Clinical Social Worker in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2012; 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.