Active NPI
Colette Brodersen, LISW
- Clinical Social Worker
- Iowa City, IA
National Provider Identifier
1669572913
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 00716
- Practice address
- 507 E College St
Iowa City, IA 52240-5115 - Phone
- (319) 338-7884
- Fax
- (319) 338-7006
- NPI assigned
- Sep 25, 2006
- 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 | 00716 | IA | Primary |
Addresses
Primary practice location
507 E College St
Iowa City, IA 52240-5115
Mailing address
507 E College St
Iowa City, IA 52240-5115
Phone (319) 338-7884
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07885 | Other | IA | MEDICARE ID |
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 |
|---|---|---|---|
| 00716 | IA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Abbe Center for Community Mental Health, Inc | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Cedar Rapids, IA
- NPI 1366299018
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197936000000",
"number": "1669572913",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "507 E COLLEGE ST",
"city": "IOWA CITY",
"state": "IA",
"postal_code": "522405115",
"telephone_number": "319-338-7884",
"fax_number": "319-338-7006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "507 E COLLEGE ST",
"city": "IOWA CITY",
"state": "IA",
"postal_code": "522405115",
"telephone_number": "319-338-7884",
"fax_number": "319-338-7006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODERSEN",
"first_name": "COLETTE",
"credential": "LISW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-25",
"last_updated": "2007-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IA",
"license": "00716",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE ID",
"identifier": "07885",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Iowa City, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.