Katie Fishman

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

11022383 Issued in UT

Practice address

600 S Geneva Rd
Orem, UT 84059-5803

Phone

(801) 877-5300

NPI assigned

Aug 4, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Nov 20, 2024 through Nov 20, 2026

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.

• Evergreen Counseling a Marriage and Family Therapy Corporation

  • Marriage & Family Therapist
  • Berkeley, CA
  • NPI 1902314297
  NPD (past)

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

{
    "created_epoch": "1596499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1003426040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4978 W FROGS LEAP DR APT 2204",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840094751",
            "telephone_number": "805-990-5128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S GENEVA RD",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840595803",
            "telephone_number": "801-877-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISHMAN",
        "first_name": "KATIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-04",
        "last_updated": "2023-11-27",
        "certification_date": "2020-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "11022383",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOPL; CERTIFIED SOCIAL WORKER",
            "identifier": "11022383-3502",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "600SGenevaRdOremUT84059",
            "affiliation": "Y",
            "affiliationName": "Telos U LLC",
            "address_1": "600 S Geneva Rd",
            "city": "Orem",
            "state": "UT",
            "country_code": "US",
            "postal_code": "840595803",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Bernadette Fish, RN, IBCLC
• Amber M Fisher
• Aspen Fu-Wei Fisher
• Emma Fisher
• Evie Fisher
• Adam Fisk
• Jordan Fitting
• Carolyn Louise Fjeldsted
• Thomas Fjeldsted, D.O.
• Taryn Flake

• Clinical Social Worker in Orem, UT
• Providers in Orem, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.