Annette L Pelletier, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L14359 Issued in OR

Practice address

62239 Powell Butte Hwy
Bend, OR 97701-9355

Phone

(541) 204-1079

NPI assigned

Apr 3, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

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

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.

• Mustang Magic Equine Therapy Services, LLC

  • Clinical Social Worker
  • Bend, OR
  • NPI 1619712148
  NPD Authorized official

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

{
    "created_epoch": "1554249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726012800000",
    "number": "1881156263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62239 POWELL BUTTE HWY",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977019355",
            "telephone_number": "541-204-1079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62239 POWELL BUTTE HWY",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977019355",
            "telephone_number": "541-204-1079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELLETIER",
        "first_name": "ANNETTE",
        "middle_name": "L",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-03",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "10167219-3501",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L14359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pediatric Heart Center of Central Oregon
• Pediatric Village Home Care LLC
• Cornelius Peeples, MD
• Nikki Peirtsegaele, DPT
• Alexander Pelaez
• Anne L Pendygraft
• Phyllis A Pengelly, WHNP
• Laura Kay Pennavaria, MD
• Margaret Pennington
• Tayler Ray Pennington, DDS

• Clinical Social Worker in Bend, OR
• Providers in Bend, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; 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.