Active NPI
Kaci L Janezic, LISW-S
- Clinical Social Worker
- Medina, OH
National Provider Identifier
1407236391
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- I.700580-S
- Practice address
- 246 Northland Dr
Medina, OH 44256-3441 - Phone
- (440) 260-8300
- Fax
- (440) 260-8575
- NPI assigned
- Jun 4, 2015
- 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 | I.700580-S | OH | Primary |
Addresses
Primary practice location
246 Northland Dr
Medina, OH 44256-3441
Mailing address
434 Eastland Rd
Berea, OH 44017-1217
Phone (440) 234-2006
Other names 1
- Kaci L Church
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I.700580-S | OH | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| FM Speech Therapy LLC | Clinical | Past | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595980800000",
"number": "1407236391",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "434 EASTLAND RD",
"city": "BEREA",
"state": "OH",
"postal_code": "440171217",
"telephone_number": "440-234-2006",
"fax_number": "440-260-8305"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "246 NORTHLAND DR",
"city": "MEDINA",
"state": "OH",
"postal_code": "442563441",
"telephone_number": "440-260-8300",
"fax_number": "440-260-8575"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JANEZIC",
"first_name": "KACI",
"middle_name": "L",
"credential": "LISW-S",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-06-04",
"last_updated": "2020-07-29",
"certification_date": "2020-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OH",
"license": "I.700580-S",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KACI",
"last_name": "CHURCH",
"middle_name": "L",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Medina, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.