NPIMap

Individual provider Active NPI

Gayle Dirksen, LSW

  • Social Worker
  • Fargo, ND
National Provider Identifier
1326468588
Registry record updated Apr 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
4668 Issued in ND
Practice address
1010 2ND Ave S
Fargo, ND 58103-8226
Phone
(701) 239-6839
NPI assigned
Apr 25, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 4668 ND Primary

Addresses

Primary practice location

1010 2ND Ave S
Fargo, ND 58103-8226

Mailing address

1010 2ND Ave S
Fargo, ND 58103-8226
Phone (701) 239-6839

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
4668NDMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Cass County Social Services Past Accepting new patients
Cass County Social Services Past Accepting new patients

Organizations & group practices 2

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": "1398384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398384000000",
    "number": "1326468588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 2ND AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581038226",
            "telephone_number": "701-239-6839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 2ND AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581038226",
            "telephone_number": "701-239-6839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIRKSEN",
        "first_name": "GAYLE",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-25",
        "last_updated": "2014-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ND",
            "license": "4668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2014; 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.