Active NPI
Kaitlyn D Miller, LCSW
- Clinical Social Worker
- Fort Collins, CO
National Provider Identifier
1265838593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 09927628
- Practice address
- 4103 Boardwalk Dr Unit 202
Fort Collins, CO 80525-5930 - Phone
- (970) 494-9870
- NPI assigned
- Nov 13, 2014
- Sex
- Female
- Sole proprietor
- No
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 | 09927628 | CO | Primary |
Addresses
Primary practice location
4103 Boardwalk Dr Unit 202
Fort Collins, CO 80525-5930
Mailing address
125 Crestridge St
Fort Collins, CO 80525-3934
Phone (970) 494-9761
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 24, 2024 through Jun 24, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09927628 | CO | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1415836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721001600000",
"number": "1265838593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 CRESTRIDGE ST",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805253934",
"telephone_number": "970-494-9761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4103 BOARDWALK DR UNIT 202",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805255930",
"telephone_number": "970-494-9870"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "KAITLYN",
"middle_name": "D",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-11-13",
"last_updated": "2024-07-15",
"certification_date": "2024-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CO",
"license": "09927628",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.