Active NPI
Kelsey Wendland-Moore, LSCSW, LCSW
- Clinical Social Worker
- Gilbert, AZ
National Provider Identifier
1518488485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 19947
- Practice address
- 4365 E Pecos Rd Ste 119
Gilbert, AZ 85295-8052 - Phone
- (480) 680-0007
- NPI assigned
- Jun 30, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 05315 | KS | |
| Clinical Social Worker | 1041C0700X | 19947 | AZ | Primary |
| Social Worker | 104100000X | 10472 | KS |
Addresses
Primary practice location
4365 E Pecos Rd Ste 119
Gilbert, AZ 85295-8052
Mailing address
4365 E Pecos Rd Ste 119
Gilbert, AZ 85295-8052
Phone (480) 680-0007
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100098080C | Other | KS | SED WAIVER |
| 100098080A | Medicaid | KS |
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 |
|---|---|---|---|
| 10472 | KS | MD | Social Worker |
| 19947 | AZ | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658275200000",
"number": "1518488485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4365 E PECOS RD STE 119",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852958052",
"telephone_number": "480-680-0007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4365 E PECOS RD STE 119",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852958052",
"telephone_number": "480-680-0007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WENDLAND-MOORE",
"first_name": "KELSEY",
"credential": "LSCSW, LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-30",
"last_updated": "2022-07-20",
"certification_date": "2022-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "KS",
"license": "05315",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AZ",
"license": "19947",
"primary": true
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "KS",
"license": "10472",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SED WAIVER",
"identifier": "100098080C",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100098080A",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gilbert, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.