Kristin Nicole Fearon, LCSW
Individual provider Active NPI Clinical Social Worker · Boulder, MT
NPI 1487029336 · NPPES record last updated Dec 3, 2015
Key facts
- NPI
- 1487029336
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- SWP-LCSW-LIC-7559 (MT)
- Practice address
- 105 Venture Way
Boulder, MT 59632 - Phone
- (406) 225-4610
- Fax
- (406) 225-3464
- NPI assigned
- Dec 3, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240228004273 | MT | Practitioner - Clinical Social Worker | 3971948001 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SWP-LCSW-LIC-7559 | MT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Montana Children'S Home & Hospital | Current |
Accepting new patients | |
| Montana Children'S Home & Hospital | Current |
Accepting new patients |
Locations
2720 10th Ave S
Great Falls, MT 59405
Phone (406) 455-2661
2755 Colonial Dr
Helena, MT 59601
Phone (406) 444-7500
2620 Shodair Dr
Helena, MT 59601
Phone (406) 444-1125
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SWP-LCSW-LIC-7559 | MT | Yes |
Addresses
Primary practice location
105 Venture Way
Boulder, MT 59632
Mailing address
PO Box 1088
105 Venture Way
Boulder, MT 59632-1088
Phone (406) 225-4610
Other names
- Kristin Nicole Resch
Other providers in Boulder, MT
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- Elkhorn Telehealth Psychiatric Services, LLC
- Abbi A Fetters
- Connie L Grenz
- Jefferson County Health Department
- Jonina Kenison
- Kristel Kishbaugh
All providers in Boulder, MT · Clinical Social Worker in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.