Individual provider Active NPI

Dana Kay Dorn, LCSW

  • Clinical Social Worker
  • Wauwatosa, WI
National Provider Identifier
1144493693
Registry record updated Apr 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6719-123 Issued in WI
Practice address
9501 W Watertown Plank Rd
Wauwatosa, WI 53226-3552
Phone
(414) 257-3141
Fax
(414) 257-3151
NPI assigned
Apr 4, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6719-123 WI Primary

Addresses

Primary practice location

9501 W Watertown Plank Rd
Wauwatosa, WI 53226-3552

Mailing address

9501 W Watertown Plank Rd
PO Box 13397
Wauwatosa, WI 53226-3552
Phone (414) 257-3141

Other identifiers 1

IdentifierTypeStateIssuer
39786100MedicaidWI

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
6719-123WIMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1207267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207267200000",
    "number": "1144493693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9501 W WATERTOWN PLANK RD",
            "address_2": "PO BOX 13397",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532263552",
            "telephone_number": "414-257-3141",
            "fax_number": "414-257-3151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9501 W WATERTOWN PLANK RD",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532263552",
            "telephone_number": "414-257-3141",
            "fax_number": "414-257-3151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DORN",
        "first_name": "DANA",
        "middle_name": "KAY",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-04",
        "last_updated": "2008-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "6719-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39786100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2008; 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.