Active NPI
Kristjana Reid, LCSW
- Clinical Social Worker
- Rockaway Beach, OR
National Provider Identifier
1508242645
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 8941519-3501
- Practice address
- 1402 NE Lake Blvd
Rockaway Beach, OR 97136-9303 - Phone
- (406) 679-2020
- NPI assigned
- Jul 30, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 8941519-3501 | UT | Primary |
| Clinical Social Worker | 1041C0700X | 8941519-3502 | UT |
Addresses
Primary practice location
1402 NE Lake Blvd
Rockaway Beach, OR 97136-9303
Mailing address
1402 NE Lake Blvd
Rockaway Beach, OR 97136-9303
Phone (406) 679-2020
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 |
|---|---|---|---|
| 8941519-3501 | UT | MD | Clinical Social Worker |
| 8941519-3502 | UT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708128000000",
"number": "1508242645",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1402 NE LAKE BLVD",
"city": "ROCKAWAY BEACH",
"state": "OR",
"postal_code": "971369303",
"telephone_number": "406-679-2020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1402 NE LAKE BLVD",
"city": "ROCKAWAY BEACH",
"state": "OR",
"postal_code": "971369303",
"telephone_number": "406-679-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REID",
"first_name": "KRISTJANA",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-07-30",
"last_updated": "2024-02-17",
"certification_date": "2024-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "8941519-3501",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "8941519-3502",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockaway Beach, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.