Katie Dominique Sammon, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2020009398 Issued in MO

Practice address

101 Progress Pkwy
Sullivan, MO 63080-2359

Phone

(888) 403-1071

NPI assigned

Jun 4, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Katie Dominique Belpulsi Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1591228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591228800000",
    "number": "1407470537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 COMMUNITY",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647358804",
            "telephone_number": "660-885-8131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 PROGRESS PKWY",
            "city": "SULLIVAN",
            "state": "MO",
            "postal_code": "630802359",
            "telephone_number": "888-403-1071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMMON",
        "first_name": "KATIE",
        "middle_name": "DOMINIQUE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-04",
        "last_updated": "2020-06-04",
        "certification_date": "2020-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2020009398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "BELPULSI",
            "middle_name": "DOMINIQUE",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jason T Riley, O.D.
• Kelcey Roehrs
• Aaron Chauncey Rowbottom, D.D.S.
• Rachel Saltzman
• Om Sam, MD
• Ravi Kishan Saripalli, M.D.
• Scantlan & Rowbottom, D.D.S., P.C.
• Mark Alan Scantlan, D.D.S.
• Stephanie Lauren Schatz, MSN, RN, FNP-C
• Devon Sarah Schlottach, FNP

• Clinical Social Worker in Sullivan, MO
• Providers in Sullivan, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 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.

Verify at the official NPI Registry.