Kirsten Hagedorn Suddath, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

992511 Issued in CO

Practice address

32721 Greens Way
Longneck, DE 19966

Phone

(720) 290-3728

NPI assigned

Jan 30, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DE, MD2 enrollments

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 2

Specialty

Clinical Social Worker

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Lighthouse Counseling Christian Ministry, LLCGroup PAC ID 1456615079, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Lighthouse Counseling Christian Ministry, LLC

  • Professional Counselor
  • Berlin, MD
  • NPI 1104272426

  MD

  Medicare reassignment Care Compare group NPD
• Fellowship Health Resources, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lincoln, RI
  • NPI 1245239680

  DE

  Medicare reassignment NPD
• Vista Medical Services, Inc.

  • Psychiatry Physician
  • Bala Cynwyd, PA
  • NPI 1659452027

  DE

  Medicare reassignment NPD

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645488000000",
    "number": "1720125909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32721 GREENS WAY",
            "city": "LONGNECK",
            "state": "DE",
            "postal_code": "19966",
            "telephone_number": "720-290-3728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32721 GREENS WAY",
            "city": "LONGNECK",
            "state": "DE",
            "postal_code": "19966",
            "telephone_number": "720-290-3728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUDDATH",
        "first_name": "KIRSTEN",
        "middle_name": "HAGEDORN",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "992511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "801856",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; 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.

Verify at the official NPI Registry.