Active NPI
Kimberly Ellyn Cohen Wasserman, LCSW
- Clinical Social Worker
- Ashland, OR
National Provider Identifier
1124258348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- L2754
- Practice address
- 99 Central Ave
Ashland, OR 97520-1787 - Phone
- (541) 482-9741
- Fax
- (541) 488-6141
- NPI assigned
- Jul 22, 2009
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | L2754 | OR | Primary |
Addresses
Primary practice location
99 Central Ave
Ashland, OR 97520-1787
Mailing address
900 E Main St
Medford, OR 97504-7136
Phone (541) 200-6854
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L2754 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564617600000",
"number": "1124258348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 E MAIN ST",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975047136",
"telephone_number": "541-200-6854"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "99 CENTRAL AVE",
"city": "ASHLAND",
"state": "OR",
"postal_code": "975201787",
"telephone_number": "541-482-9741",
"fax_number": "541-488-6141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WASSERMAN",
"first_name": "KIMBERLY",
"middle_name": "ELLYN COHEN",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-07-22",
"last_updated": "2019-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "L2754",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ashland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.