Kasie M Broe, LMSW – Clinical Social Worker

Key facts

NPI: 1366051898
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Social Worker 1041C0700X
License: 6801114947 (MI)
Practice address: 61899 M 43
Bangor, MI 49013-9621
Phone: (269) 427-5671
NPI assigned: Jul 30, 2020
Sex: Female
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Enrolled in MI
Eligible to order & refer: Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20220728001252	MI	Practitioner - Clinical Social Worker	3779965447

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
6801107291	MI	MD	Social Worker
6801114947	MI	MD	Clinical Social Worker

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Social Worker	104100000X	6801107291	MI
Clinical Social Worker	1041C0700X	6801114947	MI	Yes

Addresses

Primary practice location

61899 M 43
Bangor, MI 49013-9621

Mailing address

PO Box 249
Paw Paw, MI 49079-0249

Other names

Kasie M Walters Former name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 12, 2022.

{
    "created_epoch": "1596067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657584000000",
    "number": "1366051898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 249",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490790249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61899 M 43",
            "city": "BANGOR",
            "state": "MI",
            "postal_code": "490139621",
            "telephone_number": "269-427-5671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROE",
        "first_name": "KASIE",
        "middle_name": "M",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-30",
        "last_updated": "2022-07-12",
        "certification_date": "2022-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801107291",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801114947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KASIE",
            "last_name": "WALTERS",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bangor, MI

All providers in Bangor, MI · Clinical Social Worker in Michigan

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 12, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.