Cynthia Wallace, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW00009476 Issued in WA

Practice address

19 E Birch St Ste 103
Walla Walla, WA 99362-3084

Phone

(509) 200-7290

NPI assigned

May 24, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Specialty

Clinical Social Worker

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1337817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337817600000",
    "number": "1093075913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "553 LOCUST ST",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993623338",
            "telephone_number": "509-200-7290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 E BIRCH ST STE 103",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993623084",
            "telephone_number": "509-200-7290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CYNTHIA",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-24",
        "last_updated": "2012-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW00009476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walla Walla Public Schools
• Walla Walla Senior Citizens Center Inc (The Center at the Park)
• Walla Walla Therapy LLC
• Walla Walla Vamc
• Walla Walla Vamc
• Yajaira Waltermire, SUDPT
• Alvern Albert Walters Jr., D.PH.
• Timothy Wang, LMT
• Lauren Katriona Wardall, PHARMD
• George Robert Waring, MD

• Clinical Social Worker in Walla Walla, WA
• Providers in Walla Walla, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2012; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.