Individual provider Active NPI

Kolleen L Simons, LCSW

  • Clinical Social Worker
  • Eureka, MO
National Provider Identifier
1265434666
Registry record updated Apr 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2003000406 Issued in MO
Practice address
9 Hilltop Village Center Dr
Eureka, MO 63025-1106
Phone
(314) 374-1620
Fax
(636) 587-3742
NPI assigned
Aug 15, 2005
Last updated
Apr 12, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2010

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 2003000406 MO Primary

Addresses

Primary practice location

9 Hilltop Village Center Dr
Eureka, MO 63025-1106

Mailing address

9 Hilltop Village Center Dr
Eureka, MO 63025-1106
Phone (314) 374-1620

Other identifiers 1

IdentifierTypeStateIssuer
495864704MedicaidMO

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

LicenseStateTypeSpecialty
2003000406MOMDClinical Social Worker

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271030400000",
    "number": "1265434666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 HILLTOP VILLAGE CENTER DR",
            "city": "EUREKA",
            "state": "MO",
            "postal_code": "630251106",
            "telephone_number": "314-374-1620",
            "fax_number": "636-587-3742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 HILLTOP VILLAGE CENTER DR",
            "city": "EUREKA",
            "state": "MO",
            "postal_code": "630251106",
            "telephone_number": "314-374-1620",
            "fax_number": "636-587-3742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMONS",
        "first_name": "KOLLEEN",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-15",
        "last_updated": "2010-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2003000406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "495864704",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eureka, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2010; 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.