Erland Dale Kiddie Jr., SOCIAL WORKER

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

404 Issued in MT

Practice address

310 S Merriam Ave
Miles City, MT 59301-4620

Phone

(406) 234-7521

NPI assigned

Dec 28, 2007

Last updated

Dec 28, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1198800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198800000000",
    "number": "1669657425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 S MERRIAM AVE",
            "city": "MILES CITY",
            "state": "MT",
            "postal_code": "593014620",
            "telephone_number": "406-234-7521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 S MERRIAM AVE",
            "city": "MILES CITY",
            "state": "MT",
            "postal_code": "593014620",
            "telephone_number": "406-234-7521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIDDIE",
        "first_name": "ERLAND",
        "middle_name": "DALE",
        "name_suffix": "Jr.",
        "credential": "SOCIAL WORKER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-12-28",
        "last_updated": "2007-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "UT",
            "license": "122705-3502",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MT",
            "license": "404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Miles City, MT
• Providers in Miles City, MT by specialty
• Clinical Social Worker in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 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.

Verify at the official NPI Registry.