Katelyn Root

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801101103 Issued in MI

Practice address

640 Romence Rd Ste 211a
Portage, MI 49024-3400

Phone

(269) 588-0669

NPI assigned

Aug 8, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Intentional Journey Counseling Services, PLLC

  • Clinical Social Worker
  • Portage, MI
  • NPI 1457903122
  NPD

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

{
    "created_epoch": "1533686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606694400000",
    "number": "1023597267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 ROMENCE RD STE 211A",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490243400",
            "telephone_number": "269-588-1441",
            "fax_number": "269-775-7551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 ROMENCE RD STE 211A",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490243400",
            "telephone_number": "269-588-0669"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "140 Michigan Ave W",
            "address_purpose": "LOCATION",
            "city": "Battle Creek",
            "state": "MI",
            "postal_code": "490173602",
            "country_code": "US",
            "telephone_number": "269-966-1460",
            "fax_number": "269-966-2844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROOT",
        "first_name": "KATELYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-08",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801101103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "6801101103",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alfonso Emanuel F Rodriguez, PT
• Sarah Roeder
• Amy Nicole Rogers
• Sharickah Rogers, M.A.
• Aaron Romig
• Ashley Rosa, RN, BSN, MSN
• Benjamin Ross
• Joyce Ross
• Laura Kim Rothwell, LMT
• Faith A. Rowean, D.D.S.

• Clinical Social Worker in Portage, MI
• Providers in Portage, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; 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.