Active NPI
Katelen Fortunati
- Clinical Social Worker
- Boise, ID
National Provider Identifier
1306246756
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 40125
- Practice address
- 6126 W State St Ste 310
Boise, ID 83703-2741 - Phone
- (208) 484-5737
- NPI assigned
- Sep 3, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 | 40125 | ID | Primary |
Addresses
Primary practice location
6126 W State St Ste 310
Boise, ID 83703-2741
Mailing address
6126 W State St Ste 206
Boise, ID 83703-2741
Phone (208) 917-3114
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
| License | State | Type | Specialty |
|---|---|---|---|
| 40125 | ID | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708905600000",
"number": "1306246756",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6126 W STATE ST STE 206",
"city": "BOISE",
"state": "ID",
"postal_code": "837032741",
"telephone_number": "208-917-3114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6126 W STATE ST STE 310",
"city": "BOISE",
"state": "ID",
"postal_code": "837032741",
"telephone_number": "208-484-5737"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORTUNATI",
"first_name": "KATELEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-09-03",
"last_updated": "2024-02-26",
"certification_date": "2024-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ID",
"license": "40125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.