Active NPI
Logan M Shrader, LCSW
- Clinical Social Worker
- Belgrade, MT
National Provider Identifier
1417639352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- BBH-LCSW-LIC-64380
- Practice address
- 410 Triple Crown St
Belgrade, MT 59714-3402 - Phone
- (406) 388-1309
- NPI assigned
- Aug 1, 2023
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | BBH-LCSW-LIC-64380 | MT | Primary |
Addresses
Primary practice location
410 Triple Crown St
Belgrade, MT 59714-3402
Mailing address
410 Triple Crown St
Belgrade, MT 59714-3402
Phone (406) 388-1309
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 |
|---|---|---|---|
| BBH-LCSW-LIC-64380 | MT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Intermountain SBS | Mental Health | Past | Accepting new patients |
| Intermountain Deaconess Home for Children | Clinical | Past | Accepting new patients |
| Intermountain Deaconess Home | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Emotionally Disturbed Childrens' Residential Treatment Facility
- Helena, MT
- NPI 1518954106
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694649600000",
"number": "1417639352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 TRIPLE CROWN ST",
"city": "BELGRADE",
"state": "MT",
"postal_code": "597143402",
"telephone_number": "406-388-1309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 TRIPLE CROWN ST",
"city": "BELGRADE",
"state": "MT",
"postal_code": "597143402",
"telephone_number": "406-388-1309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHRADER",
"first_name": "LOGAN",
"middle_name": "M",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-01",
"last_updated": "2023-09-14",
"certification_date": "2023-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MT",
"license": "BBH-LCSW-LIC-64380",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Belgrade, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.