Active NPI
Shelly A Schaefferkoetter, LSW
- Social Worker
- Salt Lake City, UT
National Provider Identifier
1972876134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 4649
- Practice address
- 344 E 100 S
Salt Lake City, UT 84111 - Phone
- (801) 322-3397
- NPI assigned
- Feb 20, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Social Worker | 104100000X | 4649 | ND | Primary |
Addresses
Primary practice location
344 E 100 S
Salt Lake City, UT 84111
Mailing address
344 E 100 S
Salt Lake City, UT 84111-1700
Phone (801) 322-3397
Other practice location 1
16351 I94
Home on the Range
Sentinel Butte, ND 58654-9500
Phone (701) 872-3745 ext. 110
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 74175 | Medicaid | ND |
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 |
|---|---|---|---|
| 4649 | ND | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Home on the Range | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Emotionally Disturbed Childrens' Residential Treatment Facility
- Sentinel Butte, ND
- NPI 1114059805
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1329696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1573430400000",
"number": "1972876134",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "344 E 100 S",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841111700",
"telephone_number": "801-322-3397"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "344 E 100 S",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "84111",
"telephone_number": "801-322-3397"
}
],
"practiceLocations": [
{
"address_1": "16351 I94",
"address_2": "HOME ON THE RANGE",
"address_purpose": "LOCATION",
"city": "Sentinel Butte",
"state": "ND",
"postal_code": "586549500",
"country_code": "US",
"telephone_number": "701-872-3745 x110",
"fax_number": "701-872-3748",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SCHAEFFERKOETTER",
"first_name": "SHELLY",
"middle_name": "A",
"credential": "LSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-02-20",
"last_updated": "2019-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "ND",
"license": "4649",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "74175",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.