Active NPI
Marissa Steen Wallace, LSW
- Social Worker
- Wheat Ridge, CO
National Provider Identifier
1043857527
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- LSW.0009921712
- Practice address
- 4251 Kipling St Unit 560
Wheat Ridge, CO 80033-6800 - Phone
- (720) 490-7911
- NPI assigned
- Dec 4, 2019
- 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.0009921712 | CO | Primary |
Addresses
Primary practice location
4251 Kipling St Unit 560
Wheat Ridge, CO 80033-6800
Mailing address
1750 30TH St # 435
Boulder, CO 80301-1029
Phone (817) 734-6961
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.0009921712 | CO | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1575417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575417600000",
"number": "1043857527",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1750 30TH ST # 435",
"city": "BOULDER",
"state": "CO",
"postal_code": "803011029",
"telephone_number": "817-734-6961"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4251 KIPLING ST UNIT 560",
"city": "WHEAT RIDGE",
"state": "CO",
"postal_code": "800336800",
"telephone_number": "720-490-7911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "MARISSA",
"middle_name": "STEEN",
"name_prefix": "Ms.",
"credential": "LSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-12-04",
"last_updated": "2019-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CO",
"license": "LSW.0009921712",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wheat Ridge, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.