Jacquelyn Lee Kerkow-Dohmen, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

22546 Issued in MN

Practice address

500 Marschall Rd Ste 100
Shakopee, MN 55379-2689

Phone

(952) 448-6557

Fax

(952) 448-6047

NPI assigned

Apr 19, 2019

Last updated

May 15, 2024By the provider in NPPES

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

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Northstar RegionalGroup PAC ID 8921346669, 7 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northstar Regional

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Chaska, MN
  • NPI 1659764587
  Medicare reassignment Care Compare group NPD
• Northstar Regional

  • Clinical Medical Laboratory
  • Shakopee, MN
  • NPI 1508349234
  NPD

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

{
    "created_epoch": "1555632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1174186738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 MARSCHALL RD STE 300",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553792690",
            "telephone_number": "952-856-3932",
            "fax_number": "952-448-6047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 MARSCHALL RD STE 100",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553792689",
            "telephone_number": "952-448-6557",
            "fax_number": "952-448-6047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERKOW-DOHMEN",
        "first_name": "JACQUELYN",
        "middle_name": "LEE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-19",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "22546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Elizabeth Kearney-Bidwell, D.C.
• Jeffrey Donald Kendall, M.D.
• Herve Bertrand Kengne Mbakam, PHARMD, MS
• Elizabeth Maureen Kennedy Laliberte, PA-C
• Lara Rae Kennedy, PHARMD
• Daniel N Kessler, PSY.D.
• Mohamed Hassan Khattab, M.D.
• Brayton Kiedrowski, D.O.
• Alexi Elizabeth Kimm
• Everlyne Kemunto Kimori

• Clinical Social Worker in Shakopee, MN
• Providers in Shakopee, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.