Active NPI
Katherine P. Gorrell
- Clinical Social Worker
- Idaho Falls, ID
National Provider Identifier
1912050584
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 27603
- Practice address
- 1600 John Adams Pkwy
Suite 102
Idaho Falls, ID 83401-4300 - Phone
- (208) 529-5276
- NPI assigned
- Jan 18, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 27603 | ID | Primary |
Addresses
Primary practice location
1600 John Adams Pkwy
Suite 102
Idaho Falls, ID 83401-4300
Mailing address
534 Trejo Street
Rexburg, ID 83440
Phone (208) 356-3776
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27603 | ID | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1230595200000",
"number": "1912050584",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "534 TREJO STREET",
"city": "REXBURG",
"state": "ID",
"postal_code": "83440",
"telephone_number": "208-356-3776",
"fax_number": "208-356-9498"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 JOHN ADAMS PKWY",
"address_2": "SUITE 102",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834014300",
"telephone_number": "208-529-5276"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORRELL",
"first_name": "KATHERINE",
"middle_name": "P.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-18",
"last_updated": "2008-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ID",
"license": "27603",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.