Individual provider Active NPI

Katie Reichard, LMSW

  • Clinical Social Worker
  • Byron Center, MI
National Provider Identifier
1780067546
Registry record updated Dec 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801104046 Issued in MI
Practice address
7791 Byron Center Ave SW
Byron Center, MI 49315-8412
Phone
(616) 499-4711
Fax
(888) 336-9355
NPI assigned
Jun 29, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2024

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 6801104046 MI Primary

Addresses

Primary practice location

7791 Byron Center Ave SW
Byron Center, MI 49315-8412

Mailing address

7791 Byron Center Ave SW
Byron Center, MI 49315-8412
Phone (616) 499-4711

Other practice location 1

4940 Cascade Rd SE
suite 230
Grand Rapids, MI 49546-3708
Phone (616) 803-0643

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20200717001047 MI Practitioner - Clinical Social Worker 2365866738 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Amplified Life Network, LLCGroup PAC ID 7214350271, 5 clinicians

Practice addresses (Care Compare)

7791 Byron Ctr Ave SW
Byron Center, MI 49315-8412
Phone (616) 499-4711

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801104046MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Amplified Life Network, LLC CurrentSince May 1, 2020 Accepting new patients
Hulst Psychology and Assessment Center Past Accepting new patients
The Four Health Family Resource Center Inc PastSince Aug 1, 2018 Accepting new patients

Locations

2465 Byron Station Dr SW
Byron Center, MI 49315
Phone (616) 287-3829

Organizations & group practices 3

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": "1435536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734048000000",
    "number": "1780067546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7791 BYRON CENTER AVE SW",
            "city": "BYRON CENTER",
            "state": "MI",
            "postal_code": "493158412",
            "telephone_number": "616-499-4711",
            "fax_number": "888-336-9355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7791 BYRON CENTER AVE SW",
            "city": "BYRON CENTER",
            "state": "MI",
            "postal_code": "493158412",
            "telephone_number": "616-499-4711",
            "fax_number": "888-336-9355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4940 Cascade Rd SE",
            "address_2": "suite 230",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495463708",
            "country_code": "US",
            "telephone_number": "616-803-0643",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REICHARD",
        "first_name": "KATIE",
        "name_prefix": "Mrs.",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-29",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801104046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Byron Center, MI

Sources for this page

Verify at the official NPI Registry.