Active NPI
Klarice Ann Johnson, LCSW
- Clinical Social Worker
- Shelley, ID
National Provider Identifier
1578859963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW-36622
- Practice address
- 518 N State St
Shelley, ID 83274-1113 - Phone
- (208) 557-1450
- NPI assigned
- Jun 23, 2011
- Last updated
- Feb 26, 2023
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW-36622 | ID | Primary |
Addresses
Primary practice location
518 N State St
Shelley, ID 83274-1113
Mailing address
734 N Highway 91
Firth, ID 83236-1156
Phone (208) 757-2932
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881708832 | Medicaid | ID |
Other names 1
- Klarice Ann Tucker
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 |
|---|---|---|---|
| LCSW-36622 | ID | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Redeeming Steps | Clinical | Current | Accepting new patients |
| Alpine Counseling, PLLC | Clinical | Past | Accepting new patients |
Locations
518 N State St
Shelley, ID 83274
Phone (208) 557-1450
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677369600000",
"number": "1578859963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "734 N HIGHWAY 91",
"city": "FIRTH",
"state": "ID",
"postal_code": "832361156",
"telephone_number": "208-757-2932"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "518 N STATE ST",
"city": "SHELLEY",
"state": "ID",
"postal_code": "832741113",
"telephone_number": "208-557-1450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KLARICE",
"middle_name": "ANN",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-06-23",
"last_updated": "2023-02-26",
"certification_date": "2023-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ID",
"license": "LCSW-36622",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1881708832",
"state": "ID"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KLARICE",
"last_name": "TUCKER",
"middle_name": "ANN",
"credential": "LSCW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Shelley, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 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.