Active NPI
Crystal Douglas, LSW
- Social Worker
- Clarkston, WA
National Provider Identifier
1023827482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- LSW-41198
- Practice address
- 1370 Bridge St
Clarkston, WA 99403-2332 - Phone
- (509) 758-2568
- Fax
- (509) 758-3413
- NPI assigned
- Dec 31, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | LSW-41198 | ID | Primary |
Addresses
Primary practice location
1370 Bridge St
Clarkston, WA 99403-2332
Mailing address
1015 8TH St
Clarkston, WA 99403-2501
Phone (208) 816-0656
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
| License | State | Type | Specialty |
|---|---|---|---|
| LSW-41198 | ID | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1735603200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735603200000",
"number": "1023827482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1015 8TH ST",
"city": "CLARKSTON",
"state": "WA",
"postal_code": "994032501",
"telephone_number": "208-816-0656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1370 BRIDGE ST",
"city": "CLARKSTON",
"state": "WA",
"postal_code": "994032332",
"telephone_number": "509-758-2568",
"fax_number": "509-758-3413"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "CRYSTAL",
"credential": "LSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-12-31",
"last_updated": "2024-12-31",
"certification_date": "2024-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "ID",
"license": "LSW-41198",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarkston, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.