Stephen Kern, LSCSW
Individual provider Active NPI Clinical Social Worker · Loa, UT
NPI 1336407568 · NPPES record last updated Jun 7, 2018
Key facts
- NPI
- 1336407568
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 6178738-3501 (UT)
- Practice address
- 1764 West Aspen Lane
Loa, UT 84747 - Phone
- (435) 836-2272
- Fax
- (435) 836-2274
- NPI assigned
- Apr 25, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6178738-3501 | UT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elizabeth Layton Center, Inc. | Current |
Accepting new patients | |
| Legacy Treatment Center LLC | Past | Accepting new patients |
Locations
2537 Eisenhower Rd
Ottawa, KS 66067
Phone (785) 242-2183
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 4174 | KS | |
| Clinical Social Worker | 1041C0700X | 6178738-3501 | UT | Yes |
Addresses
Primary practice location
1764 West Aspen Lane
Loa, UT 84747
Mailing address
PO Box 353
Loa, UT 84747-0353
Phone (435) 836-2272
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200966490A | Medicaid | KS |
Other providers in Loa, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.