Active NPI
Julianna Lane
- Clinical Social Worker
- Tieton, WA
National Provider Identifier
1093374738
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 10371624-3501
- Practice address
- 620 Pongala Rd
Tieton, WA 98947-9534 - Phone
- (630) 479-9390
- NPI assigned
- Jun 6, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 10371624-3501 | UT | Primary |
| Mental Health Counselor | 101YM0800X |
Addresses
Primary practice location
620 Pongala Rd
Tieton, WA 98947-9534
Mailing address
620 Pongala Rd
Tieton, WA 98947-9534
Phone (630) 479-9390
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 |
|---|---|---|---|
| 10371624-3501 | UT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1751155200000",
"number": "1093374738",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "620 PONGALA RD",
"city": "TIETON",
"state": "WA",
"postal_code": "989479534",
"telephone_number": "630-479-9390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 PONGALA RD",
"city": "TIETON",
"state": "WA",
"postal_code": "989479534",
"telephone_number": "630-479-9390"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANE",
"first_name": "JULIANNA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-06-06",
"last_updated": "2025-06-29",
"certification_date": "2025-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "10371624-3501",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tieton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.