Colleen L Kennedy, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

25024 Issued in MN

Practice address

980 S Tower Rd
Fergus Falls, MN 56537-5505

Phone

(218) 736-6987

Fax

(218) 736-6980

NPI assigned

Apr 19, 2018

Last updated

Apr 19, 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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

University of North Dakota School of Medicine

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Lakeland Mental Health Center IncGroup PAC ID 1759291891, 39 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Lakeland Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fergus Falls, MN
  • NPI 1366480287
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1524096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524096000000",
    "number": "1861989378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "980 S TOWER RD",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565375505",
            "telephone_number": "218-736-6987",
            "fax_number": "218-736-6980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 S TOWER RD",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565375505",
            "telephone_number": "218-736-6987",
            "fax_number": "218-736-6980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "COLLEEN",
        "middle_name": "L",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-19",
        "last_updated": "2018-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "25024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly I Schroeder DDS
• Tanya Kelsen
• Darryl S Kemp Jr., MD
• Randall James Kempfer, O.D.
• Tara Amber Kempfer, O.D.
• Kessel Group Home Inc
• Matthew Lee Kessler, PHARM.D.
• Ibrahim Ali Khan, MD
• Anna Kimball, RN, PHN
• Angela Sue King, LPN

• Clinical Social Worker in Fergus Falls, MN
• Providers in Fergus Falls, MN by specialty
• Clinical Social Worker in Minnesota

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