Active NPI
Rodney Kanikkeberg
- Mental Health Counselor
- Moscow, ID
National Provider Identifier
1417308495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LPC-6234
- Practice address
- 317 W 6TH St
Ste 208
Moscow, ID 83843-2321 - Phone
- (208) 882-3504
- Fax
- (208) 882-3572
- NPI assigned
- Jun 30, 2016
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LPC-6234 | ID | Primary |
Addresses
Primary practice location
317 W 6TH St
Ste 208
Moscow, ID 83843-2321
Mailing address
317 W 6TH St
Ste 208
Moscow, ID 83843-2321
Phone (208) 882-3504
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-6234 | ID | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467244800000",
"number": "1417308495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "317 W 6TH ST",
"address_2": "STE 208",
"city": "MOSCOW",
"state": "ID",
"postal_code": "838432321",
"telephone_number": "208-882-3504",
"fax_number": "208-882-3572"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "317 W 6TH ST",
"address_2": "STE 208",
"city": "MOSCOW",
"state": "ID",
"postal_code": "838432321",
"telephone_number": "208-882-3504",
"fax_number": "208-882-3572"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANIKKEBERG",
"first_name": "RODNEY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-06-30",
"last_updated": "2016-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "ID",
"license": "LPC-6234",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moscow, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.