Individual provider Active NPI

Daniel Gagnon

  • Clinical Social Worker
  • Bellevue, WA
National Provider Identifier
1073867875
Registry record updated Oct 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LW61279321 Issued in WA
Practice address
15731 NE 8TH St
Bellevue, WA 98008-4083
Phone
(206) 420-6424
NPI assigned
Oct 31, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Practitioner 225400000X
Clinical Social Worker 1041C0700X LW61279321 WA Primary

Addresses

Primary practice location

15731 NE 8TH St
Bellevue, WA 98008-4083

Mailing address

15731 NE 8TH St
Bellevue, WA 98008-4083

Other practice location 1

2560 Business Pkwy Ste B
Minden, NV 89423-8961
Phone (775) 392-2650

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

LicenseStateTypeSpecialty
LW61279321WAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Hallowell Todaro Center PLLC PastSince Apr 1, 2021 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1351641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1073867875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15731 NE 8TH ST",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980084083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15731 NE 8TH ST",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980084083",
            "telephone_number": "206-420-6424"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2560 Business Pkwy Ste B",
            "address_purpose": "LOCATION",
            "city": "Minden",
            "state": "NV",
            "postal_code": "894238961",
            "country_code": "US",
            "telephone_number": "775-392-2650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAGNON",
        "first_name": "DANIEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-31",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW61279321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 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.

Verify at the official NPI Registry.