Angela Elizabeth Gerritsen

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

287197-3501 Issued in UT

Practice address

1048 W 10250 S
South Jordan, UT 84095-4517

Phone

(801) 557-8362

NPI assigned

Apr 19, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Angela Elizabeth Gerritsen Hickok Professional name

Medicare fee-for-service enrollment

Enrolled in ID

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

Locations

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.

• Deer Oaks Mental Health Associates PC

  • Clinical Psychologist
  • Las Cruces, NM
  • NPI 1134175763

  ID, Single Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1397865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651104000000",
    "number": "1912327743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1048 W 10250 S",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840954517",
            "telephone_number": "801-557-8362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1048 W 10250 S",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840954517",
            "telephone_number": "801-557-8362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERRITSEN",
        "first_name": "ANGELA",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-19",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "287197-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "GERRITSEN HICKOK",
            "middle_name": "ELIZABETH",
            "credential": "LCSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Thayne Henrie Gardner, DDS
• Chuck Hung Gee, PA-C
• Genesis Dental of South Jordan
• Jonathan Wesley George, PHARMD.
• Gerardo F. Maymi, D.M.D. PC
• Kelsee Geurts
• Amberli Geverts
• Atusa Ghadikolai
• Steven Giang, DPT
• Gibson Ventures, LLC

• Clinical Social Worker in South Jordan, UT
• Providers in South Jordan, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; 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.