Kathryn Davis Tidd

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

28095 Issued in MN

Practice address

815 37TH Ave S
Moorhead, MN 56560-5524

Phone

(701) 451-4811

Fax

(651) 925-0057

NPI assigned

Jun 3, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Kathryn Davis Professional name

Medicare fee-for-service enrollment

Enrolled in ND, MN2 enrollments

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 2

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 and National Provider Directory roles.

• Southeast Behavioral Health Clinic

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Fargo, ND
  • NPI 1932146941
  Medicare reassignment NPD
• Village Family Service Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fargo, ND
  • NPI 1568492353

  Clinical, MN

  Medicare reassignment NPD
• Village Family Service Center

  • Substance Abuse Rehabilitation Facility
  • Fargo, ND
  • NPI 1952679318
  NPD

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

{
    "created_epoch": "1401753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1285047738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9859",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581069859",
            "telephone_number": "701-451-4900",
            "fax_number": "651-925-0057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 37TH AVE S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565605524",
            "telephone_number": "701-451-4811",
            "fax_number": "651-925-0057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDD",
        "first_name": "KATHRYN",
        "middle_name": "DAVIS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-03",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "28095",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ND",
            "license": "5057",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHRYN",
            "last_name": "DAVIS",
            "credential": "LICSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Thrive Behavioral Network III, LLC
• Amy Tichy
• Tickel Chiropractic, P.C.
• Tammy Marie Tickel, D.C.
• William David Tickel, D.C.
• John Michael Tinjum, M.D.
• Kebbeh Reed Tinnie, RN
• Jill Todd
• Seth Tollefson
• Tomorrow, LLC

• Clinical Social Worker in Moorhead, MN
• Providers in Moorhead, 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 Jan 21, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.