Active NPI
Teresa Wiedemann, LICSW
- Clinical Social Worker
- Walla Walla, WA
National Provider Identifier
1063790509
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LW 60111377
- Practice address
- 139 Russet Rd
Walla Walla, WA 99362-8253 - Phone
- (509) 520-4370
- NPI assigned
- Aug 2, 2011
- Last updated
- Apr 9, 2012
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LW 60111377 | WA | Primary |
Addresses
Primary practice location
139 Russet Rd
Walla Walla, WA 99362-8253
Mailing address
139 Russet Rd
Walla Walla, WA 99362-8253
Phone (509) 520-4370
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 |
|---|---|---|---|
| LW 60111377 | WA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333929600000",
"number": "1063790509",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "139 RUSSET RD",
"city": "WALLA WALLA",
"state": "WA",
"postal_code": "993628253",
"telephone_number": "509-520-4370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "139 RUSSET RD",
"city": "WALLA WALLA",
"state": "WA",
"postal_code": "993628253",
"telephone_number": "509-520-4370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIEDEMANN",
"first_name": "TERESA",
"name_prefix": "Ms.",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-08-02",
"last_updated": "2012-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WA",
"license": "LW 60111377",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Walla Walla, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.