Melanie Dierickx, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

099976 Issued in IA

Practice address

218 1/2 N 2ND St
Eldridge, IA 52748-1208

Phone

(563) 676-2357

NPI assigned

Jun 22, 2020

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 22, 2020.

{
    "created_epoch": "1592784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592784000000",
    "number": "1972129336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 E GEORGE WASHINGTON BLVD",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528031230",
            "telephone_number": "563-676-2357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 1/2 N 2ND ST",
            "city": "ELDRIDGE",
            "state": "IA",
            "postal_code": "527481208",
            "telephone_number": "563-676-2357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIERICKX",
        "first_name": "MELANIE",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-22",
        "last_updated": "2020-06-22",
        "certification_date": "2020-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IA",
            "license": "099976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF SOCIAL WORK LICENSE",
            "identifier": "099976",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "http://www.heartandsolutions.net/davenport.html",
            "affiliation": "N",
            "endpointDescription": "Agency Website Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "415 E George Washington Blvd",
            "city": "Davenport",
            "state": "IA",
            "country_code": "US",
            "postal_code": "528031230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• All providers in Eldridge, IA
• Social Worker in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.