Shauna Leigh Ketcham, ASW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

79168

Practice address

441 Park Ave
San Jose, CA 95110-2615

Phone

(408) 287-2460

NPI assigned

Jan 24, 2018

Last updated

Jan 24, 2018By 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 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

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.

• County of San Joaquin

  dba San Joaquin County Clinic Manteca

  • Multi-Specialty Clinic/Center
  • Manteca, CA
  • NPI 1417407636
  NPD
• San Joaquin Behavioral Health Services

  dba San Joaquin County Behavioral Health Services

  • Community/Behavioral Health Agency
  • Stockton, CA
  • NPI 1215028931

  Mental Health

  NPD
• San Joaquin County Behavioral Health Services

  dba SJC-MHS Crisis Intervention Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Stockton, CA
  • NPI 1447467725
  NPD

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

{
    "created_epoch": "1516752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516752000000",
    "number": "1841798865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "441 PARK AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951102615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "441 PARK AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951102615",
            "telephone_number": "408-287-2460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETCHAM",
        "first_name": "SHAUNA",
        "middle_name": "LEIGH",
        "name_prefix": "Ms.",
        "credential": "ASW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-24",
        "last_updated": "2018-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "79168",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": "79168",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OUT- PATIENT MENTAL HEATH CENTER",
            "identifier": "1871855916",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shambhavi Kerur
• Ritwik Akshay Keshav
• Kathleen O'Shea Kesten, CFNP
• Randi J Kestler, M.D.
• Vanikaa Keswani, DO
• Nutat Ketebe
• Kevin W. Calvert DDS Inc
• Nissa Marie Keyashian, M.D.
• Sanaz Keyhan, MD
• Richard W Keyme, MD

• Clinical Social Worker in San Jose, CA
• Providers in San Jose, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.