KIMBERLY VASICEK (NPI# 1740665397) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740665397 |
| Entity Type | Individual |
| Full Name | KIMBERLY VASICEK |
| Credential | BA |
| Practice Address |
19401 Northline Rd Bldg 5 Southgate MI 48195 |
| Mailing Address |
19401 Northline Rd Bldg 5 Southgate MI 48195-2277 |
| Practice Telephone | 7347857700 |
| Enumeration Date | 2015-07-24 |
| Last Update Date | 2019-09-12 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | 6803086749 | MI | Other Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 17910 Van Dyke, Detroit, MI 48138 | 3133685200 |
| Street Address |
19401 NORTHLINE RD BLDG 5 |
| City | SOUTHGATE |
| State | MI |
| Zip Code | 48195 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699011684 | Rachel Zaran | Speech-Language Pathologist | 19401 Northline Rd Bldg 5, Southgate, MI 48195-2277 | 2012-12-18 |
| 1942859269 | Rejillia Johnston | Student in an Organized Health Care Education/Training Program | 19401 Northline Rd Bldg 5, Southgate, MI 48195-2277 | 2019-09-09 |
| 1700375383 | Elizabeth Burgess | Counselor | 19401 Northline Rd Bldg 5, Southgate, MI 48195-2277 | 2018-05-09 |
| 1639691694 | Lynda Johnson | Social Worker | 19401 Northline Rd Bldg 5, Southgate, MI 48195-2277 | 2017-07-12 |
| 1265968895 | Jillian Out | Psychologist | 19401 Northline Rd Bldg 5, Southgate, MI 48195-2277 | 2017-05-02 |
| 1215478359 | Christa Campbell | Case Manager/Care Coordinator | 19401 Northline Rd Bldg 5, Southgate, MI 48195-2277 | 2017-03-08 |
| 1851843916 | Brittany Nicole Page | Social Worker | 19401 Northline Rd Bldg 5, Southgate, MI 48195-2277 | 2016-10-25 |
| 1184039224 | Breana Witte | Speech-Language Pathologist | 19401 Northline Rd Bldg 5, Southgate, MI 48195-2277 | 2014-06-27 |
| 1417388224 | Gwendolyn Hooks | Psychologist | 19401 Northline Rd Bldg 5, Southgate, MI 48195-2277 | 2013-12-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780206656 | Destiny D Harris | Social Worker | 14799, Southgate, MI 48195 | 2020-05-13 |
| 1285102368 | Svs Vision Inc | Eyewear Supplier (Equipment, not the service) | 16256 Fort St, Southgate, MI 48195 | 2018-11-07 |
| 1003382979 | Saran Charisse Watts | Case Manager/Care Coordinator | 31101 Allen Rd, Building 5, Southgate, MI 48195 | 2018-10-18 |
| 1255824025 | Kiesta Janell Lindsey | Social Worker | 13101 Allen Rd Bldg 4-f, Southgate, MI 48195 | 2018-06-07 |
| 1417473224 | Suzette Michele Watson | Nurse Practitioner | 14319 Dix-toledo, Southgate, MI 48195 | 2017-08-15 |
| 1275069486 | Liza Du Plessis | Student in an Organized Health Care Education/Training Program | 13111 Allen Road, Southgate, MI 48195 | 2017-05-08 |
| 1497290456 | Beaumont Health | Clinic/Center | 15777 Northline, Southgate, MI 48195 | 2016-12-30 |
| 1184172876 | Felicia Wilson | Licensed Practical Nurse | 15771 Wildemere, Southgate, MI 48195 | 2016-09-12 |
| 1225487978 | Stacey Petrick-strickland | Technician, Other | 12189 Agnes, Southgate, MI 48195 | 2016-06-03 |
| 1205298486 | Ashley Francis | Hearing Instrument Specialist | 18800 Eureka Rd., Southgate, MICHIGAN 48195 | 2016-03-25 |
| Find all providers in zip 48195 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003382979 | Saran Charisse Watts | Case Manager/Care Coordinator | 31101 Allen Rd, Building 5, Southgate, MI 48195 | 2018-10-18 |
| 1528544558 | Hallie Marie Fraser | Case Manager/Care Coordinator | 15679 Churchill St, Southgate, MI 48195-3290 | 2018-07-12 |
| 1861943441 | Elizabeth Shannon Pierson | Case Manager/Care Coordinator | 12679 Longtin St, Southgate, MI 48195-1770 | 2016-10-19 |
| 1679910525 | Liana Michelle Ratcliff | Case Manager/Care Coordinator | 14799 Dix - Toledo, Team Mental Health Svcs, Southgate, MI 48195 | 2013-06-03 |
| 1861031916 | Brianna R Simmons | Case Manager/Care Coordinator | 19401 Northline Rd, Southgate, MI 48195-2277 | 2020-01-06 |
| 1588200240 | William David Schaefer | Case Manager/Care Coordinator | 13101 Allen Rd Bldg 4, Southgate, MI 48195-2216 | 2019-11-18 |
| 1801453485 | Jeremiah Scott | Case Manager/Care Coordinator | 14799 Dix Toledo Rd, Southgate, MI 48195-2507 | 2019-05-20 |
| 1902365471 | Leah Lyn Longuski | Case Manager/Care Coordinator | 14799 Dix Toledo Rd, Southgate, MI 48195-2507 | 2019-03-14 |
| 1780143446 | Nicole Fuerstnau | Case Manager/Care Coordinator | 13101 Allen Rd, Southgate, MI 48195-2216 | 2019-03-12 |
| 1366906893 | Katelyn Rose Slominski | Case Manager/Care Coordinator | 19401 Northline Rd, Southgate, MI 48195-2277 | 2019-01-29 |
| Find all providers in SOUTHGATE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.