Individual provider Active NPI

Kendra Marie Liedtke, MSW, LCSW

  • Clinical Social Worker
  • Aurora, CO
National Provider Identifier
1295811891
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
992871 Issued in CO
Practice address
11059 E Bethany Dr
Suite 200
Aurora, CO 80014-2622
Phone
(303) 617-2331
Fax
(303) 617-2398
NPI assigned
Oct 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 992871 CO Primary

Addresses

Primary practice location

11059 E Bethany Dr
Suite 200
Aurora, CO 80014-2622

Mailing address

11059 E Bethany Dr
Suite 200
Aurora, CO 80014-2622
Phone (303) 617-2331

Other identifiers 1

IdentifierTypeStateIssuer
58587748MedicaidCO

Other names 1

  • Kendra Marie Lubrant Former name

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20040805000296 CO Practitioner - Clinical Social Worker 4981675592 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1189 S Perry St
Castle Rock, CO 80104-1959
Phone (720) 295-1199

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
992871COMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
In the Moment Counseling, LLC Clinical CurrentSince Apr 15, 2015 Accepting new patients

Locations

1189 S Perry St
Ste 110D
Castle Rock, CO 80104
Phone (719) 387-8685

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295811891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11059 E BETHANY DR",
            "address_2": "SUITE 200",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800142622",
            "telephone_number": "303-617-2331",
            "fax_number": "303-617-2398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11059 E BETHANY DR",
            "address_2": "SUITE 200",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800142622",
            "telephone_number": "303-617-2331",
            "fax_number": "303-617-2398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEDTKE",
        "first_name": "KENDRA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "992871",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "58587748",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENDRA",
            "last_name": "LUBRANT",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Aurora, CO

Sources for this page

Verify at the official NPI Registry.