Justina Kelsey Dodge, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

18186 Issued in MT

Practice address

725 West Central Ave
#208
Missoula, MT 59801-6800

Phone

(406) 926-1231

Fax

(406) 926-1231

NPI assigned

Aug 17, 2016

Last updated

Sep 5, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Justina Kelsey Hagen Former name

Medicare fee-for-service enrollment

Enrolled in MT

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

Specialty

Clinical Social Worker

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Mending Minds Therapy LLC

  • Clinical Social Worker
  • Missoula, MT
  • NPI 1902311269
  Medicare reassignment NPD

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

{
    "created_epoch": "1471392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536105600000",
    "number": "1821543000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 WEST CENTRAL AVENUE #208",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598016800",
            "telephone_number": "406-926-1231",
            "fax_number": "406-926-1231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 WEST CENTRAL AVE",
            "address_2": "#208",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598016800",
            "telephone_number": "406-926-1231",
            "fax_number": "406-926-1231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DODGE",
        "first_name": "JUSTINA",
        "middle_name": "KELSEY",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-17",
        "last_updated": "2018-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MT",
            "license": "18186",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MT",
            "license": "BBH-LCSW-LIC-18186",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUSTINA",
            "last_name": "HAGEN",
            "middle_name": "KELSEY",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Doctor Amy Haynes Inc (Full Circle Natural Medical Clinic)
• Doctor Carla LLC
• Dodge Works PT, Inc Dba Alpine Physical Therapy (Alpine Physical Therapy)
• Dodge Works PT, Inc Dba Alpine Physical Therapy
• Brent Alan Dodge, PT
• Scott M Doherty, PA
• Kevin Brian Dohr, PH.D.
• Paul K. Dokey, LCSW
• Kathryn Dolese, PT
• Jesse Jeffrey Doll, PA-C

• Clinical Social Worker in Missoula, MT
• Providers in Missoula, MT by specialty
• Clinical Social Worker in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.