Shannon R Kerrick, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-37496 Issued in ID

Practice address

493 Eastland Dr
Twin Falls, ID 83301-7441

Phone

(208) 410-4866

NPI assigned

Jul 11, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• The Bridge Counseling, LLC

  • Clinical Social Worker
  • Twin Falls, ID
  • NPI 1710547245
  NPD (past) Authorized official

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

{
    "created_epoch": "1468195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566172800000",
    "number": "1811349129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2818 SUNRAY LOOP",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833016700",
            "telephone_number": "208-410-4866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "493 EASTLAND DR",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833017441",
            "telephone_number": "208-410-4866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERRICK",
        "first_name": "SHANNON",
        "middle_name": "R",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-11",
        "last_updated": "2019-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "8005634-3501",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SD",
            "license": "3558",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-37496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David L Kemp, M.D.
• Jackie L Kennedy, BACHELORS, LPN
• Kenneth C Romney MD Inc
• Gaige Kepner, DDS
• Melody Kerner, LMSW
• Cathi Baily Ketterling, PHARM. D
• Lindsey Ketterling, DPT, CSCS
• Kevin L Hamblin DDS
• Matthew Jordan Kezele, LPC
• William Kezele

• Clinical Social Worker in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2019; 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.