Active NPI
Sandra Kathryn Wilson, LCSW, ASOTP
- Clinical Social Worker
- Beaumont, TX
National Provider Identifier
1346664661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 23427
- Practice address
- 5825 Phelan Blvd
Suite 101
Beaumont, TX 77706-6249 - Phone
- (409) 860-0001
- Fax
- (409) 860-0010
- NPI assigned
- Feb 6, 2014
- Last updated
- Dec 12, 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 | 23427 | TX | Primary |
Addresses
Primary practice location
5825 Phelan Blvd
Suite 101
Beaumont, TX 77706-6249
Mailing address
5825 Phelan Blvd
Suite 101
Beaumont, TX 77706-6249
Phone (409) 860-0001
Other names 1
- Sandra Kathryn Bruce
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23427 | TX | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Skull Honey LLC | Clinical | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Social Worker
- Round Rock, TX
- NPI 1669003554
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1391644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418342400000",
"number": "1346664661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5825 PHELAN BLVD",
"address_2": "SUITE 101",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777066249",
"telephone_number": "409-860-0001",
"fax_number": "409-860-0010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5825 PHELAN BLVD",
"address_2": "SUITE 101",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777066249",
"telephone_number": "409-860-0001",
"fax_number": "409-860-0010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "SANDRA",
"middle_name": "KATHRYN",
"credential": "LCSW, ASOTP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-02-06",
"last_updated": "2014-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "23427",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SANDRA",
"last_name": "BRUCE",
"middle_name": "KATHRYN",
"credential": "LCSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Beaumont, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2014; 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.