Susan Kay Herzog, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

513 Issued in ND

Practice address

1110 College Dr
Suite 215
Bismarck, ND 58501-1207

Phone

(701) 471-1044

NPI assigned

Jun 12, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Susan Kay McWilliams Former name

Medicare fee-for-service enrollment

Enrolled in ND

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.

• Decoteau Trauma-Informed Care & Practice, PLLC

  • Psychologist
  • Bismarck, ND
  • NPI 1174890016
  Medicare reassignment NPD

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281830400000",
    "number": "1992747042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E MAIN AVE",
            "address_2": "SUITE 102-A",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585013857",
            "telephone_number": "701-471-1044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 COLLEGE DR",
            "address_2": "SUITE 215",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585011207",
            "telephone_number": "701-471-1044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERZOG",
        "first_name": "SUSAN",
        "middle_name": "KAY",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-12",
        "last_updated": "2010-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ND",
            "license": "513",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PIN",
            "identifier": "N16133",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19187",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ND PIN",
            "identifier": "016133",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "MCWILLIAMS",
            "middle_name": "KAY",
            "credential": "LICSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Chelsi Jo Hertz
• Dawn Lynn Hertz, PHARMD
• Dwight J Hertz, MD
• Troy Vernon Hertz, PHARMD
• William Hertz, FNP-C
• Kevin A Hessinger, CRNA
• Hetland Ear Nose Throat PC
• Andrew R Hetland, M.D.
• Bruce M Hetland, MD
• Madison Jae Hetletved, APRN, CNP

• Clinical Social Worker in Bismarck, ND
• Providers in Bismarck, ND by specialty
• Clinical Social Worker in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2010; 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.