Mica Deann Sutton, LCSM

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2020017507 Issued in MO

Practice address

10640 Business 21
Hillsboro, MO 63050-5039

Phone

(618) 877-4420

NPI assigned

Jun 17, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Mica Deann Kianetski Former name

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Chestnut Health Systems Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Bloomington, IL
  • NPI 1366431686

  MO

  Medicare reassignment NPD
• Chestnut Health Systems Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wood River, IL
  • NPI 1235941311
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593043200000",
    "number": "1639339229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "448 WYLIE DR",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617615405",
            "telephone_number": "888-924-3786",
            "fax_number": "309-451-7763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10640 BUSINESS 21",
            "city": "HILLSBORO",
            "state": "MO",
            "postal_code": "630505039",
            "telephone_number": "618-877-4420"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1507 E. Race St.",
            "address_purpose": "LOCATION",
            "city": "Searcy",
            "state": "AR",
            "postal_code": "721434661",
            "country_code": "US",
            "telephone_number": "501-305-2359",
            "fax_number": "501-305-2348",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUTTON",
        "first_name": "MICA",
        "middle_name": "DEANN",
        "credential": "LCSM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-17",
        "last_updated": "2020-06-25",
        "certification_date": "2020-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AR",
            "license": "5137-M",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2020017507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICA",
            "last_name": "KIANETSKI",
            "middle_name": "DEANN",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Special Services Cooperative of Jefferson County
• David John Stansfield, DO
• Megan Lee Stayton, DMD
• Stephanie Barkley, LLC
• Kaitlyn Strzelecki
• Tonya Taber
• Melissa Tate
• Ashlee Nicole Tesson, RDN, LDN
• Emily Thompson
• Jacqueline Toole, LPTA

• Clinical Social Worker in Hillsboro, MO
• Providers in Hillsboro, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.