Kathleen J Vandenberg

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2088 Issued in CO

Practice address

305 Carpenter Rd
Fort Collins, CO 80525-4248

Phone

(970) 663-3500

Fax

(970) 292-0898

NPI assigned

Aug 10, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kathleen V Eckert Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1344556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1790032589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 CARPENTER RD",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805254248",
            "telephone_number": "970-663-3500",
            "fax_number": "970-292-0898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 CARPENTER RD",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805254248",
            "telephone_number": "970-663-3500",
            "fax_number": "970-292-0898"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2950 E Harmony Rd",
            "address_purpose": "LOCATION",
            "city": "Fort Collins",
            "state": "CO",
            "postal_code": "805283419",
            "country_code": "US",
            "telephone_number": "303-338-4545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDENBERG",
        "first_name": "KATHLEEN",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-10",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "2088",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NONE",
            "identifier": "NONE",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "CAREQUALITY",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2950 E Harmony Rd",
            "city": "Fort Collins",
            "state": "CO",
            "country_code": "US",
            "postal_code": "805283419",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KATHLEEN",
            "last_name": "ECKERT",
            "middle_name": "V",
            "credential": "MSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amber Marie Vance, NP
• Jason R Vance, PA-C
• Madeline Vancuren, RDN
• Mark J Vandelist, RPH
• Lara Vanden Hoek, CNP
• Jesse Cree Vandenburg
• Raymond P Vandenhoven, MD
• Karen Vander Broek
• Jacob Vander Leest, ,MACP, ADDC
• Shonny H Vander Vliet, ATC

• Clinical Social Worker in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Clinical Social Worker in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; 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.