Shad Burnett St Paul, MSW, SUDP, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW61381427 Issued in WA

Practice address

39 Short Cut Road
Inchelium, WA 99138-0039

Phone

(509) 722-7640

NPI assigned

Mar 26, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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

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.

• Colville Nation Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Inchelium, WA
  • NPI 1043335961

  TX

  Medicare reassignment NPD
• Colville Nation Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Inchelium, WA
  • NPI 1679697155
  NPD

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

{
    "created_epoch": "1427328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1033503107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290",
            "city": "INCHELIUM",
            "state": "WA",
            "postal_code": "991380290",
            "telephone_number": "509-722-7640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 SHORT CUT ROAD",
            "city": "INCHELIUM",
            "state": "WA",
            "postal_code": "991380039",
            "telephone_number": "509-722-7640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ST PAUL",
        "first_name": "SHAD",
        "middle_name": "BURNETT",
        "name_prefix": "Mr.",
        "credential": "MSW, SUDP, LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-26",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP60472921",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW61381427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremiah Johnson Salmond, PHARMD
• Emily Lorraine Sardual, NP
• Jazminn Simpson, CM60786110
• Kimberly Rose Simpson, MA
• Susan Dawn Solomon-Hopkins, APRN
• Brenda Christine Starkey, NAC, X-RAY TECH
• Crystal Gale Stensgar, RN
• Rebecca Stillwell, AP 60897709
• Brandi Swan, MA-R
• Tyrell Allen Tonasket, L.M.P.

• All providers in Inchelium, WA
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; 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.