Kenric Glenn Gordon, LMSW
NPI 1114540804ActiveIndividual· Social Worker· Chubbuck, ID
Social Worker (LMSW) with Mental Health Specialists, practicing in Chubbuck, Idaho. Enrolled in Medicare as practitioner - clinical social worker.
Overview
| NPI | 1114540804 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | LMSW |
| Sole proprietor | No |
| NPI issued | May 28, 2020 |
| Last updated in NPPES | May 28, 2020 |
| Certified by provider | May 28, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Social Worker Primary | 104100000X | LMSW-39661 | ID |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Clinical Social Worker (ID) |
|---|
Education and affiliations
| Graduation year | 2021 |
|---|---|
| Medicare specialty | Clinical Social Worker |
| Telehealth | Offers telehealth |
Medical group
- Mental Health SpecialistsPocatello, ID · 11 clinicians
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