Individual provider Active NPI

Katherine Brown Dusenbury, LICSW

  • Clinical Social Worker
  • Grand Forks, ND
National Provider Identifier
1720150642
Registry record updated Sep 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
4021 Issued in ND
Practice address
2808 17TH Ave S
Grand Forks, ND 58201
Phone
(701) 746-8376
Fax
(701) 746-9872
NPI assigned
Nov 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 4021 ND Primary

Addresses

Primary practice location

2808 17TH Ave S
Grand Forks, ND 58201

Mailing address

2808 17TH Ave S
Grand Forks, ND 58201-4010
Phone (701) 746-8376

Other practice location 1

151 S 4th St
Suite 401
Grand Forks, ND 58201-4715
Phone (701) 795-3000

Other identifiers 2

IdentifierTypeStateIssuer
054519MedicaidND
027727OtherNDBCBS PROVIDER NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
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

Enrollment IDStateProvider typePAC IDDetails
I20070309000281 ND Practitioner - Clinical Social Worker 1557464625 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lipp Carlson Witucki and Associates LTDGroup PAC ID 2062408701, 10 clinicians

Practice addresses (Care Compare)

2808 17TH Ave S
Grand Forks, ND 58201-4010
Phone (701) 746-8376

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Lipp, Carlson, Witucki & Associates, LTD CurrentSince Sep 1, 2018 Accepting new patients

Locations

2808 17th Ave S
Grand Forks, ND 58201
Phone (701) 746-8376

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.

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536105600000",
    "number": "1720150642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2808 17TH AVE S",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014010",
            "telephone_number": "701-746-8376",
            "fax_number": "701-746-9872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2808 17TH AVE S",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58201",
            "telephone_number": "701-746-8376",
            "fax_number": "701-746-9872"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "151 S 4th St",
            "address_2": "Suite 401",
            "address_purpose": "LOCATION",
            "city": "Grand Forks",
            "state": "ND",
            "postal_code": "582014715",
            "country_code": "US",
            "telephone_number": "701-795-3000",
            "fax_number": "701-795-3050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUSENBURY",
        "first_name": "KATHERINE",
        "middle_name": "BROWN",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2018-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ND",
            "license": "4021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "054519",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "027727",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

Verify at the official NPI Registry.