Kelly Cameron Lindberg, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

302082 Issued in MN

Practice address

407 Washington St
Monticello, MN 55362-8815

Phone

(763) 295-4001

Fax

(763) 295-5086

NPI assigned

Feb 14, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Ms. Kelly Cameron Smith Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1202947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351555200000",
    "number": "1306014162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 WASHINGTON ST",
            "city": "MONTICELLO",
            "state": "MN",
            "postal_code": "553628815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 WASHINGTON ST",
            "city": "MONTICELLO",
            "state": "MN",
            "postal_code": "553628815",
            "telephone_number": "763-295-4001",
            "fax_number": "763-295-5086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LINDBERG",
        "first_name": "KELLY",
        "middle_name": "CAMERON",
        "name_prefix": "Mrs.",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-14",
        "last_updated": "2012-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "302082",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LADC",
            "identifier": "302082",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "SMITH",
            "middle_name": "CAMERON",
            "prefix": "MS.",
            "credential": "LACD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Addiction (Substance Use Disorder) Counselor in Monticello, MN
• Providers in Monticello, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2012; 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.