NPIMap

Organization Active NPI

Katie Shannon Licsw LLC

Doing business as Connect Us Therapy

  • Clinical Social Worker
  • Williston, ND
National Provider Identifier
1265091235
Registry record updated Dec 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
KATIE SHANNON LICSW LLC
Doing business as
Connect Us Therapy
Practice address
2224 1St Ave W Ste 4
Williston, ND 58801-6286
Phone
(701) 572-3335
Fax
(701) 572-3337
NPI assigned
Jun 12, 2019
Last updated
Dec 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2021

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

Authorized official

Name
Katie Brianne Shannon, LCSWNPI 1295862621
Title
Owner
Phone
(701) 572-3335

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NU Primary

Addresses

Primary practice location

2224 1St Ave W Ste 4
Williston, ND 58801-6286

Mailing address

2224 1St Ave W Ste 4
Williston, ND 58801-6286
Phone (701) 572-3335

Other practice location 1

810 N Welo St
Tioga, ND 58852-7157
Phone (701) 572-3335

Other names 1

  • Connect Us Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211129000427 ND Part B Supplier - Clinic/Group Practice 2062802457 Receives reassigned benefits from 3 practitioners
Practice locations: Tioga, ND; Williston, ND

National Provider Directory

National Provider Directory

Locations

1500 14th St W
Ste 230
Williston, ND 58801
Phone (701) 572-3335

2224 1st Ave W
Ste 4
Williston, ND 58801
Phone (701) 572-3335

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1560297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640217600000",
    "number": "1265091235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2224 1ST AVE W STE 4",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588016286",
            "telephone_number": "701-572-3335",
            "fax_number": "701-572-3337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2224 1ST AVE W STE 4",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588016286",
            "telephone_number": "701-572-3335",
            "fax_number": "701-572-3337"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "810 N Welo St",
            "address_purpose": "LOCATION",
            "city": "Tioga",
            "state": "ND",
            "postal_code": "588527157",
            "country_code": "US",
            "telephone_number": "701-572-3335",
            "fax_number": "701-572-3337",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KATIE SHANNON LICSW LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-12",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-23",
        "status": "A",
        "authorized_official_last_name": "SHANNON",
        "authorized_official_first_name": "KATIE",
        "authorized_official_middle_name": "BRIANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "701-572-3335",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Connect Us Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williston, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.