Individual provider Active NPI

Katryna Joubert, MSW

  • Social Worker
  • Fairlawn, OH
National Provider Identifier
1992019988
Registry record updated Oct 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
7695680-3502 Issued in UT
Practice address
50 Baker Blvd Ste 5a
Fairlawn, OH 44333-3603
Phone
(216) 772-3188
NPI assigned
Aug 2, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 10, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 7695680-3502 UT Primary

Addresses

Primary practice location

50 Baker Blvd Ste 5a
Fairlawn, OH 44333-3603

Mailing address

494 S Trailside Dr
Layton, UT 84041-3862
Phone (801) 458-3130

Other identifiers 2

IdentifierTypeStateIssuer
260022408OtherUTRAILROAD MEDICARE
876000308007MedicaidUT

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

LicenseStateTypeSpecialty
7695680-3502UTMDSocial Worker

NPI Registry JSON

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

{
    "created_epoch": "1280707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1992019988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "494 S TRAILSIDE DR",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840413862",
            "telephone_number": "801-458-3130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 BAKER BLVD STE 5A",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443333603",
            "telephone_number": "216-772-3188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOUBERT",
        "first_name": "KATRYNA",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-02",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "UT",
            "license": "7695680-3502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "260022408",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "876000308007",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairlawn, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2022; 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.