Keaujahne Kierra Champane Polk

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

117698 Issued in CA

Practice address

10425 Crenshaw Blvd Apt 5
Inglewood, CA 90303-4462

Phone

(562) 607-5788

NPI assigned

Aug 19, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Coping Cabinet Licensed Clinical Social Worker

  • Adult Mental Health Clinic/Center
  • Los Angeles, CA
  • NPI 1902621642
  NPD Authorized official

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

{
    "created_epoch": "1566172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732579200000",
    "number": "1376190033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10425 CRENSHAW BLVD APT 5",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903034462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10425 CRENSHAW BLVD APT 5",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903034462",
            "telephone_number": "562-607-5788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLK",
        "first_name": "KEAUJAHNE",
        "middle_name": "KIERRA CHAMPANE",
        "name_prefix": "Miss",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-19",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "117698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Plancarte Rodriguez
• Planned Parenthood Los Angeles
• Plasmagenix Medical Corp
• PLD Family Home Care
• Lauren Dorothy Plummer
• Veronika Pomyateeva
• Brian W Pond, PPS
• Pooran Dalwani DDS Inc
• Jessica Poovan, PHARM.D.
• Rickie L Porter

• Clinical Social Worker in Inglewood, CA
• Providers in Inglewood, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; 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.