Active NPI
Rachel Ruth Pence, LCSW
- Clinical Social Worker
- Kodiak, AK
National Provider Identifier
1386654283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 363
- Practice address
- 717 E Rezanof Dr
Kodiak, AK 99615-6416 - Phone
- (907) 481-2400
- Fax
- (907) 481-2419
- NPI assigned
- Aug 9, 2006
- Sex
- Female
- Sole proprietor
- No
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 | 363 | AK | Primary |
Addresses
Primary practice location
717 E Rezanof Dr
Kodiak, AK 99615-6416
Mailing address
717 E Rezanof Dr
Kodiak, AK 99615-6416
Phone (907) 481-2400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MH 2237 & DA 2237 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311033600000",
"number": "1386654283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "717 E REZANOF DR",
"city": "KODIAK",
"state": "AK",
"postal_code": "996156416",
"telephone_number": "907-481-2400",
"fax_number": "907-481-2419"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "717 E REZANOF DR",
"city": "KODIAK",
"state": "AK",
"postal_code": "996156416",
"telephone_number": "907-481-2400",
"fax_number": "907-481-2419"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENCE",
"first_name": "RACHEL",
"middle_name": "RUTH",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-09",
"last_updated": "2011-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AK",
"license": "363",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "MH 2237 & DA 2237",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kodiak, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.