KERRI LEE BORDELON, MSW, CSW — NPI 1750194049 (Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical in PROVIDENCE, UT)

CMS-1500 Box 24J / 33a • NPI

1750194049

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

1041C0700X (CMS 80)

Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical

Box 32 Service Location & ZIP+4

277 N SPRING CREEK PKWY, PROVIDENCE, UT, 84332-9775

✓ 9-Digit EDI 837 ZIP+4 (84332-9775)

Practice Phone & Referral Fax

(435) 753-0253

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1750194049 (KERRI LEE BORDELON, MSW, CSW) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1750194049` (NPI-1 Individual Practitioner)
Provider / Legal Name	KERRI LEE BORDELON, MSW, CSW
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical NUCC Code: `1041C0700X` (Social Worker, Clinical)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	277 N SPRING CREEK PKWY, PROVIDENCE, UT, 84332-9775
Practice Telephone / Fax	Tel: (435) 753-0253
Administrative Mailing Address	1835 S 1395 W, LOGAN, UT, 84321-6979
Enumeration & Last Sync	Enumerated: 2025-01-30 \| CMS Record Updated: 2025-01-30

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

277 N SPRING CREEK PKWY, PROVIDENCE, UT, 84332-9775

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Plain-English Taxonomy & CMS Crosswalk (1041C0700X)

What Does Taxonomy Code 1041C0700X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1041C0700X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 80 (Licensed Clinical Social Worker)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Social Worker, Clinical for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (KERRI LEE BORDELON, MSW, CSW)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`1041C0700X` — Social Worker, Clinical Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical	State: UT \| License: `11827522-3502` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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KERRI LEE BORDELON, MSW, CSW (NPI #1750194049)