Active NPI
Shannon Carol Kempf, LICSW
- Clinical Social Worker
- Wadena, MN
National Provider Identifier
1598072894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 18686
- Practice address
- 503 Jefferson St S
Wadena, MN 56482-1843 - Phone
- (218) 675-5101
- Fax
- (801) 340-9860
- NPI assigned
- Sep 8, 2010
- Last updated
- Sep 8, 2015
- 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 | 18686 | MN | Primary |
Addresses
Primary practice location
503 Jefferson St S
Wadena, MN 56482-1843
Mailing address
PO Box 471
Hackensack, MN 56452-0471
Phone (218) 675-5101
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
112 State 371
Hackensack, MN 56452-2192
Phone (218) 675-5101
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Birch Lake Counseling LLC | Current | Accepting new patients |
Locations
15 Dayton Ave SE
Wadena, MN 56482
Phone (218) 675-5101
Organizations & group practices 1
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.
-
- Clinic/Center
- Hackensack, MN
- NPI 1760646715
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441670400000",
"number": "1598072894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 471",
"city": "HACKENSACK",
"state": "MN",
"postal_code": "564520471",
"telephone_number": "218-675-5101",
"fax_number": "801-340-9860"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "503 JEFFERSON ST S",
"city": "WADENA",
"state": "MN",
"postal_code": "564821843",
"telephone_number": "218-675-5101",
"fax_number": "801-340-9860"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEMPF",
"first_name": "SHANNON",
"middle_name": "CAROL",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-08",
"last_updated": "2015-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "18686",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wadena, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.