Connie J Kersenbrock, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

CONNIE J KERSENBROCK, LCSW

Practice address

300 SE Reed Market Rd Ste 110
Bend, OR 97702-2237

Phone

(620) 966-6925

NPI assigned

Sep 30, 2019

Organization subpart

No

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

Authorized official

Name

Connie Kersenbrock, LCSW

Title

Owner

Phone

(620) 966-6925

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1569801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569801600000",
    "number": "1710528989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 SW CANYON DR APT 3",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977562054",
            "telephone_number": "620-966-6925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 SE REED MARKET RD STE 110",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977022237",
            "telephone_number": "620-966-6925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNIE J KERSENBROCK, LCSW",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-30",
        "last_updated": "2019-09-30",
        "status": "A",
        "authorized_official_last_name": "KERSENBROCK",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "620-966-6925",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Bend, OR
• Providers in Bend, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2019; 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.