Larry Wayne Breedlove

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CW023022 Issued in PA

Practice address

1906 N Juniata St
Hollidaysburg, PA 16648-1908

Phone

(814) 695-2984

Fax

(814) 695-2110

NPI assigned

Mar 8, 2007

Last updated

Jul 28, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Soar for Life

  • Clinical Social Worker
  • Hollidaysburg, PA
  • NPI 1689233777
  NPD

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1326179474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1906 N JUNIATA ST",
            "city": "HOLLIDAYSBURG",
            "state": "PA",
            "postal_code": "166481908",
            "telephone_number": "814-695-2984",
            "fax_number": "814-695-2110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1906 N JUNIATA ST",
            "city": "HOLLIDAYSBURG",
            "state": "PA",
            "postal_code": "166481908",
            "telephone_number": "814-695-2984",
            "fax_number": "814-695-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREEDLOVE",
        "first_name": "LARRY",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-08",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW023022",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STAFF CODE",
            "identifier": "SYC7165",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blair County Plastic Surgery Inc.
• Blair Foot and Ankle LLC
• Blair Medical Associates
• Blair Medical Associates - Hollidaysburg
• Bradley Peters LPC
• Brianna L Breon, SLP
• Gretta G Brown, OD
• Janelle Brumbaugh
• Renee Brunner, LCSW
• Nicole Marie Bukosky

• Clinical Social Worker in Hollidaysburg, PA
• Providers in Hollidaysburg, PA by specialty
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2023; 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.