Active NPI
Scott Douglas Nordstrom, LCSW
- Clinical Social Worker
- Susanville, CA
National Provider Identifier
1154534147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS 14899
- Practice address
- 555 Hospital LN
Susanville, CA 96130-4918 - Phone
- (530) 251-8199
- Fax
- (530) 251-2662
- NPI assigned
- May 7, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | LCS 14899 | CA | Primary |
Addresses
Primary practice location
555 Hospital LN
Susanville, CA 96130-4918
Mailing address
691-225 Las Plumas Way
Susanville, CA 96130
Phone (530) 257-9321
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801 | Medicaid | CA |
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
| License | State | Type | Specialty |
|---|---|---|---|
| LCS 14899 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623196800000",
"number": "1154534147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "691-225 LAS PLUMAS WAY",
"city": "SUSANVILLE",
"state": "CA",
"postal_code": "96130",
"telephone_number": "530-257-9321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 HOSPITAL LN",
"city": "SUSANVILLE",
"state": "CA",
"postal_code": "961304918",
"telephone_number": "530-251-8199",
"fax_number": "530-251-2662"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NORDSTROM",
"first_name": "SCOTT",
"middle_name": "DOUGLAS",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-07",
"last_updated": "2021-06-09",
"certification_date": "2021-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS 14899",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1801",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Susanville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.