Sandra M Koellmann, ASW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

86201 Issued in CA

Practice address

3767 Central Ave
San Diego, CA 92105-2599

Phone

(619) 584-4010

Fax

(619) 278-0770

NPI assigned

Jul 7, 2020

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Dec 18, 2023 through Dec 18, 2027

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Stepping Stone San Diego

  • Substance Use Disorder Rehabilitation Clinic/Center
  • San Diego, CA
  • NPI 1083388854
  NPD
• Stepping Stone of San Diego, Inc.

  • Substance Abuse Rehabilitation Facility
  • San Diego, CA
  • NPI 1013045905
  NPD (past)

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

{
    "created_epoch": "1594080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594080000000",
    "number": "1073131033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3767 CENTRAL AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921052599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3767 CENTRAL AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921052599",
            "telephone_number": "619-584-4010",
            "fax_number": "619-278-0770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOELLMANN",
        "first_name": "SANDRA",
        "middle_name": "M",
        "credential": "ASW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-07",
        "last_updated": "2020-07-07",
        "certification_date": "2020-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "86201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary F. Kodiath, NP
• Koe Medical Consulting, Inc.
• Kristen Koeblin
• Ann Jelyn Koehn
• Edward Charles Koellhoffer, MD, PHD
• Alessandra Nichole Koenig
• Heleana Koenig
• Jenny Bryne Koenig
• Jill Anne Koenig, PSY.D
• Katherine Koenig

• Clinical Social Worker in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2020; 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.