Kristina Nicholas Anderson, LSW, MASTERS STUDENT

Primary specialty

Social WorkerTaxonomy code 104100000X

License

LSW-2298 Issued in ID

Practice address

5624 N Government Way
Suite 7B
Dalton Gardens, ID 83815-7350

Phone

(208) 762-9890

Fax

(208) 762-9892

NPI assigned

Apr 25, 2007

Last updated

Jul 8, 2007By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Diversified Social Services, Inc.

  • Community/Behavioral Health Agency
  • Dalton Gardens, ID
  • NPI 1720141906
  NPD (past) Authorized official

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790904779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5624 N GOVERNMENT WAY",
            "address_2": "SUITE 7B",
            "city": "DALTON GARDENS",
            "state": "ID",
            "postal_code": "838157350",
            "telephone_number": "208-762-9890",
            "fax_number": "208-762-9892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5624 N GOVERNMENT WAY",
            "address_2": "SUITE 7B",
            "city": "DALTON GARDENS",
            "state": "ID",
            "postal_code": "838157350",
            "telephone_number": "208-762-9890",
            "fax_number": "208-762-9892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLAS ANDERSON",
        "first_name": "KRISTINA",
        "name_prefix": "Mrs.",
        "credential": "LSW, MASTERS STUDENT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ID",
            "license": "LSW-2298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUR OCCUP LICEN - LSW",
            "identifier": "LSW-2298",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kami Luanne Mason, OTR/L
• Christian Mayfield
• Madison Mackenzie Miller, OTD, OTR
• Patricia Morgan, REEGT, RPSGT
• Cynthia Elaine Nelson, O.T.R./L
• Open Mind Wellness
• Kevin Jon Penner, CCC-SLP
• Gabrielle Phillips
• Playwell Pediatric Therapy LLC
• Cindy Jean Radavich, APRN

• Social Worker in Dalton Gardens, ID
• Providers in Dalton Gardens, ID by specialty
• Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.