Todd Gjerdevig

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

37507 Issued in TX

Legal business name

TODD GJERDEVIG

Practice address

1111 S Main St
Suite 132
Grapevine, TX 76051-5577

Phone

(817) 865-5032

NPI assigned

Apr 3, 2015

Organization subpart

No

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

Authorized official

Name

Todd Gjerdevig, LCSWNPI 1073764957

Title

Owner

Phone

(817) 908-0296

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Todd Allen Gjerdevig, LCSW

  • Clinical Social Worker
  • Southlake, TX
  • NPI 1073764957
  NPD (past) Authorized official

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

{
    "created_epoch": "1428019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428019200000",
    "number": "1376938613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 S MAIN ST",
            "address_2": "SUITE 132",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760515577",
            "telephone_number": "817-865-5032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 S MAIN ST",
            "address_2": "SUITE 132",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760515577",
            "telephone_number": "817-865-5032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TODD GJERDEVIG",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-03",
        "last_updated": "2015-04-03",
        "status": "A",
        "authorized_official_last_name": "GJERDEVIG",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-908-0296",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "37507",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207198701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Timothy J Rost, M.D. P.a.
• Evelyn Carol Ting, N.P.
• Jenna Elizabeth Tinsley, PT
• Margaret Tobolka
• Today Dental of Grapevine PLLC
• Loretta B Tolliver, ED.D.
• John Tong, MD
• Toothhq Dental Specialists Grapevine PLLC
• Domonique Torbert, PSY.D.
• Total Anesthesia Care, PLLC

• Clinical Social Worker in Grapevine, TX
• Providers in Grapevine, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2015; 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.